Step 1

Review any existing files the Department may have on the applicant.

Direct Support Staff to copy relevant information from old file(s) and place into new case file, such as medical & eye reports and social security data and any other information that would be relevant or would be helpful to know for this case. Make sure you specify what you want (by stating it or marking with a sticky note).

Field staff will have to contact DM office for this information found in old files.

Step 2

Obtain the application packet. The Department’s application package includes:

• Application for Vocational Rehabilitation Services
• Health Assessment Questionnaire
• Work History / Job Skills Form
• IDB’s Applicant’s Rights and Responsibilities Brochure
• Voter Registration Information
• Iowa Client Assistance Program Brochure
• Eligibility Determination Waiver
• Ticket to Work Assignment Form
• Release of Information Forms:
  • University of Iowa Hospitals Consent to Release of Information
  • Authority for Release and Exchange of Information
  • Authorization to Release Information - Employment & Earnings

  (Some of the above documents are available for download: Application Documents.)

Step 3

Tell the applicant that all information gathered will be kept strictly confidential. (Refer to the Department’s Policy on Confidentiality for more information.)

Step 4

Complete the Demographic information.

Demographic App Fields Image

Guidelines for this section:

• Date: Enter the date you completed the application with the client. This date should also be used on the Health Assessment Questionnaire and the release of information forms (University of Iowa Hospitals, Authority for Release and Exchange of Information, and Authorization to Release Information - Employment & Earnings).
   
• If the applicant is not a U.S. Citizen, make a copy of documentation proving the applicant’s work status. (For example, provide a copy of the individual’s work permit.) Be sure to note in the Application case note which documentation you obtained to verify the applicant is able to legally work. If the applicant is not able to legally work, stop. Do not continue to complete the application. Suggest other ways the applicant can get needed services.

Step 5

Complete the Disability information.

Disability App Fields Image

Guidelines for this section:

In the Cause of Blindness field, enter the cause given by the applicant.

In the Primary Impairment Type field, enter the type of impairment. In most instances, this will be Blindness or Other Visual Impairments.

In the Primary Impairment Cause field, enter the 911 code that corresponds to the cause you entered as the Cause of Blindness.

For example: An applicant indicates the cause of his blindness is Fuch’s Dystrophy. Complete the Cause of Blindness, Primary Impairment Type, and Primary Impairment Cause fields as follows:

Cause of Blindness: Fuch’s Dystrophy

Primary Impairment Type: Blindness
Primary Impairment Cause: Congenital Condition or Birth Injury

For a list of types, choose the Impairment Types link.
For a list of blindness causes and corresponding 911 impairment cause codes, choose the Cause of Blindness and Cause Codes link.

If a secondary impairment is indicated, complete the Secondary Impairment Type and Secondary Impairment Cause fields using the same guidelines. (Choose the appropriate impairment type from the Impairment Types list and the appropriate 911 impairment cause code for the Secondary Impairment Cause field.)

Step 6

Complete the Sources of Support information.

Guidelines for this section:

You must enter information into these fields:

• SSI Blind Amount
• SSI Disabled Amount
• SSDI Amount

If the applicant does not receive either Title XVI (Supplemental Security Income) or Title II (Social Security Disability Insurance), enter 0 in the amount fields.

Definitions

Monthly Family Income: Enter monthly earnings from employment (self, spouse, other) and other sources not listed below.

SSI Aged: Individual is age 65 or older and receives SSI. Enter amount received each month.

SSI Blind: Individual is statutory blind and receives SSI. Enter amount received each month. (List the amount received as a state supplement to blind individuals under General Assistance.)

SSI Disabled: Individual is disabled (not statutory blind) and receives SSI.

SSI: Supplemental Security Income (Title XVI) is a needs based program for low income, disabled individuals. These individuals have limited income and resources and do not qualify for SSDI because they do not have enough quarters of coverage.

Do not list the Social Security Retirement Benefit amount in the SSI categories! List it under Other Public Support.

SSDI Amount: Enter amount received each month.

SSDI: Social Security Disability Insurance (Title II) is an insurance based program. Individuals qualify for this program based on disability and whether they have enough quarters of coverage. (In other words, if they have paid into the system through taxes.)

Do not list the Social Security Retirement Benefit amount in the SSDI category! List it under Other Public Support.

TANF Amount: Payment received from the Temporary Assistance for Needy Families (TANF) program. The Family Investment Program (FIP) is Iowa’s TANF program. FIP provides cash assistance to needy families, as they become self-supporting so children may be cared for in their own homes or in the homes of relatives.

General Assistance: Payment made by a state or local government; includes state supplements to the federal SSI program. (In Iowa, individual’s receiving SSI for blindness receive an additional $22 state supplement. That amount should be listed in the General Assistance field.)

Veteran’s Disability Benefits: Payment made by the Department of Veteran Affairs for partial or total disability.

Other Disability Benefits: Cash payments to individuals by reason of disability other than those listed above, such as (a) federal, state, or local governments for public employee retirement on disability, (b) Railroad Retirement Board, or SSA’s Black Lung program.

Other Public Support: Cash payments to individuals paid for any other reason, such as retirement and survivor payments made by federal, state, and local governments. Unemployment insurance benefits should be listed here.

Primary Support Source options are: Info not available; Personal Income; Family and Friends; Public Support; or All other sources.

If the applicant is a transition age student (14 - 24) at time of application and has received services from the Iowa Braille School or an Area Education Agency (AEA), write “Yes” for Previous IEP. If an Individualized Education Plan (IEP) has been completed, have the applicant sign a release to appropriate party in order to obtain the most recent copy of the IEP.

 

Step 7

Complete the Medical Insurance Coverage and Employment (at Application) information.

Medical and Employment App Fields Image

Guidelines for this section:

Work Status at Application options are:

• Information is not available/Other

• Employment without Supports

• Extended Employment

• Self-employment (except BEP)

• Business Enterprise Program (BEP)

• Homemaker

• Unpaid Family Worker

• Employment with Supports

• Not employed: Secondary Ed. Student

• Not employed: All other Students

• Not employed: Trainee/Intern/Volunteer

• Not employed: Other

Step 8

Complete the Health Assessment Information.

Health Assessment App Fields

Guidelines for this section:

In the application Health Assessment fields, enter a brief summary of the information you obtained when you completed the Health Assessment Questionnaire with the client.

Step 9

Always complete the checklist at the end of the application form.

Checklist App Fields Image

Guidelines for this section:

• The Department automatically requests SSA information if you have entered a dollar amount in any of the Social Security fields. If you have a special request for SSA information, send an e-mail request to Linda T.
   
• If the applicant wants to register to vote, complete the Voter Registration form with the applicant. Give the completed form to Support Staff with other application documents.
   
• You do not need to mention these items again in the case note.

Step 10

Verify that the applicant or the applicant’s authorized representative has signed and dated these documents:

• Application
• Health Assessment Questionnaire
• Release of Information Forms:
  • University of Iowa Hospitals Consent to Release of Information
  • Authority for Release and Exchange of Information
  • Authorization to Release Information - Employment & Earnings

REMINDER: The date should be the same on all of these documents.

Step 11

Ask the applicant if he / she has copies of medical reports, grade transcripts, or other information useful for determining eligibility or planning services. (If so, ask for copies and file with completed application documents.)

Step 12

Ask the applicant for secondary contact information, such as the name and primary telephone number of a relative or friend who we can contact. (This information may be helpful if applicant’s contact information is lost or outdated.)

Step 1

Complete the application case note. The case note should include:

• Conclusions you have drawn based on information you have gathered so far.
  • For example, if the Individualized Education Plan indicates that, with assistive technology, this individual is capable of attaining college prep grades, then state this conclusion in your assessment remarks. Similarly, if medical information shows several complications related to diabetes and their vocational goal involves strenuous work, you should note this as well.
     
• Description of the applicant’s current attitude about blindness.
   
• Brief description about the applicant that reflects his / her personal situation. (For example, information about applicant’s family situation, description of work and educational history, problems or issues applicant is facing, accomplishments, etc. )
   
• Any relevant information not covered in the supporting documentation received to date.
   
• Description of the authorizations you have issued or plan to issue for this applicant. (For example, if you feel a hearing screening is needed, indicate in the case note that you will be authorizing payment for a screening and the amount authorized.)
   
• Transition Information, if applicable
   
• A statement indicating the case moves into Status 02 - Applicant.

Step 2

Compile the application packet for Support Staff. The application packet should contain:

• Application (Refer to application data entry options below.)
• Health Assessment Questionnaire
• Signed and dated release forms:
  • University of Iowa Hospitals Consent to Release of Information
  • Authority for Release and Exchange of Information
  • Authorization to Release Information - Employment & Earnings
• Completed Work History (if applicable)
• Completed Voter Registration form (if applicable)
• Other documents provided by the applicant, such as medical reports and grade transcripts.

Step 3

Prepare all application data and the application case note for entry into eFORCE. You may provide that information by:

1. Dictating all information required for the application and the case note for Support Staff to enter into eFORCE. The dictation should include:

• Information you have written on the paper application.
• Information for the application case note. (Refer to Step 1 for information to include in the application case note)
• When necessary, direct Support Staff to send authorization letters or complete other special instructions.

2. Entering the application information into eFORCE yourself and dictating the accompanying case note for Support Staff to enter into eFORCE; or:

3. Entering the application and case note information into eFORCE yourself.

• For instructions on entering application data, choose the Entering Application Data into eFORCE link.

• Do not provide application or application case note as an electronic document (Word or e-mail).

• Please keep all application documents together.

Step 4

Prepare the Log Sheet for Support Staff. Include the following information on the log sheet:

Date Contd: Enter the date you met with client to complete the application.
Client: Enter client’s first and last name as it appears on the application.
Entry: Enter “Application” in the Entry column.

If you have entered the application data into eFORCE, note this on the log sheet

Support Staff will enter information into the the Date Recd, Date Typd, and Date Rev fields.

Step 5

Place the Log Sheet on top of application documents and submit as one packet to Support Staff.

Step 1

Review the application packet submitted by Counselor. The packet should contain:

• Completed Log Sheet
   
• Application.
       Application information may be provided by:
  • Dictation
  • Paper Document
  • Log sheet note indicating Counselor has entered the application data into eFORCE.
     
• Health Assessment Questionnaire
   
• Signed and dated release forms:
  • University of Iowa Hospitals Consent to Release of Information
  • Authority for Release and Exchange of Information
  • Authorization to Release Information - Employment & Earnings

The packet may also contain these items:

• Completed Work History (if applicable)
• Completed Voter Registration form (if applicable)
• Other documents provided by the applicant, such as medical reports, grade transcripts, IEP.

Step 2

Assemble the paper case file folder: dividers, fastener, and name label. (Choose the Case File Organization link for more information).

Step 3

Enter all application data into eFORCE. (For instructions, choose the Entering Application Data into eFORCE link.)

Note: Counselor or Teacher may have already entered application data into eFORCE. (The Log sheet should indicate this.) If so, verify that all screens have been completed properly and print information required for the paper case file.

Step 4

If requested by Counselor, send letters.

Letter authorizing payment for exam.
Letter requesting existing medical records.
VA medical letter.

Note: If possible, obtain Counselor’s signature. If Counselor is not readily available, use his / her electronic signature or sign the Counselor’s name and indicate with your initials.

Step 5

If completed, mail Voter Registration form.

Step 6

Insert all printed documents (application, case note, signed authorizations, etc.) into the paper case file folder.

Be sure to file document under the correct divider.

For new clients, pull the Referral Form from the Pending file and put into paper case file. (The Referral form should be the last item in the paper case file. Place a blank sheet of paper on top of the Referral form. Write “Pending” on it.)

Note: If existing client, no referral form is necessary.

For more information about correct filing and printing, choose the Case File Organization link.

Step 7

Enter information from handwritten log sheet into Counselor’s electronic log file.

The Counselor’s electronic log file is in their folder in FieldOp folder.

Step 8

Print portion of log sheet that pertains to the current case. Attach printed log sheet to new case file folder.

Step 9

Place case file into the VR Counselor Supervisor’s mail slot.

When the supervisor has reviewed the case file, she will return it to Support Staff for filing.

Step 10

Retrieve old case files, and put old files with new case file in an accordion folder.

Step 11

Open client’s record in eFORCE, and change Physical File Location on the Demographics page to R for Rehab.

Note: Steps 10 & 11 can only be done by Des Moines office Support Staff.