The following steps are being taken on the part of the Intake Specialist for all telephone calls that indicate the person wants to apply for VR services. The primary person responsible for starting the referral/application process is the Intake Specialist (I.S.) However, the counselor is also able to complete the application process with any client. It is preferred that the counselor complete the process for transition-age students. The counselor has autonomy to request assistance from support staff at any time throughout this process.

1. The I.S. is one option for an initial contact with a referral.

   1. The I.S. requests information regarding medical providers for purpose of completing the Release of Information forms.

   2. The IS completes case notes of all communication with the referral.

2. I.S. will begin the application over the phone (on paper), I.S. will scan and send the form to Support Staff (SS).

3. A packet will be mailed to the referral containing the following documents:

   1. Application, for completion/review by the referral.

   2. Application Release for Services, one copy

      1. The document will have a sticky note to label the signature line

   3. Voter registration form

      1. Initialed by IS and a sticky note to label signature line

   4. Releases of Information to be signed

   5. Client Assistance Program

   6. Rights and Responsibilities

   7. A self-addressed stamped envelope for return

      1. Attn: VR program

   8. A generic instructional letter to the referral (end of this document)

   9. Assign referral to support staff

4. If the referral states he/she cannot fill out the form, the I.S. will offer to record his/her answers to the application questions. The application will be photocopied for I.S. records and the originals mailed to the referral for signature and return. The I.S. will also read the Application Release for Services and the Voter Registration form, and any other documents if requested. I.S. will follow up with referral if the documents have not been received within 10 - 20 days.

5. Upon receipt of the VR application documents:

   1. Support Staff (SS) will

      1. Move referral to 02 using receipt of signed application as 02 date and enter application information into eFORCE

         1. The only information required to move a client into status 02 is the application release for services. The counselor will follow up with any missing documentation.

      2. Obtain counselor’s signature on required documents

      3. Enter ROIs into eFORCE

      4. Letter and ROI out to medical providers

      5. Complete case note with information received

      6. Email counselor case note

   2. Counselor will contact the applicant within 14 days of 02 status date

      1. Complete health assessment with applicant

      2. Review rights and responsibilities/CAP with client

      3. Obtain additional information needed for the application or eligibility

      4. Enter work history information into eFORCE

      5. Finish application screen in eFORCE

      6. Complete case note

Letter to client:

Dear Vocational Rehabilitation Applicant,

It was my pleasure to visit with you regarding the services at the Iowa Department for the Blind!

Enclosed in this packet, there are several documents requiring your signature. Sticky notes have been placed just below the signature lines.

To-Do List:

1. Please sign the following forms right above the sticky notes:

• Application Release for Services (Department copy)

• Releases of Information (there may be more than one)

• Voter Registration form

2. Please return the signed documents in the self-addressed stamped envelope

3. We will need a copy of your most recent medical eye examination report to assist in determining your eligibility for services. Information required on this medical report is:

• Your best corrected visual acuity in the better eye

• Visual Field results (If test was performed)

• Your visual diagnosis and prognosis

4. If possible, please fax the eye reports to our office at 515-242-5781, ATTN: VR program.

The two brochures in the packet are for your information and will be reviewed with you by your VR counselor after we receive your application for services. These brochures include information about your Rights and Responsibilities as a VR client and about the Iowa Client Assistance Program.

Please feel free to contact me with any questions at: 515-901-8621 or ann.fremont@blind.state.ia.us

The Iowa Department for the Blind is looking forward to assisting you!

Sincerely,