Completing the 704 Report: SILCs & Centers A National Teleconference on Independent Living TRAINING MANUAL December 12, 1995 Permission is given to duplicate portions of this manual providing that the following credit is given to the project: Developed as part of the IL NETWORK: NCIL/ILRU National Training and Technical Assistance Project. Training Manual Production Team: Cynthia Dresden Dawn Heinsohn Laurel Richards Dawn Kemp-Moye Whipple Dutton IL NETWORK: NCIL/ILRU National Training and Technical Assistance Project ILRU Program 2323 S. Shepherd, Suite 1000 Houston, TX 77019 (713) 520-0232 TTY: 520-5136 Fax: 520-5785 NCIL 2111 Wilson Blvd., Suite 405 Arlington, VA 22201 (703) 525-3406 TTY: 525-3407 Fax: 525-3409 TABLE OF CONTENTS Agenda Teleconference Objectives Teleconference Presenters About the Presenters About the IL NETWORK Information Related to 704 Report Key Demographic Findings from the 704 Reports Purpose of the 704 Annual Performance Report Key Features of the 704 Annual Performance Report Federal Requirements for Submission of 704 Reports: 722 States Federal Requirements for Submission of 704 Reports: 723 States Sample 704 Performance Report for SILCs Idaho SILC: Report to the Governor Sample 704 Performance Report: Idaho SILC Sample 704 Performance Report for CILs Sample CIL Program Narrative: Arizona Bridge to IL Sample CIL Work Plan: Arizona Bridge to IL Sample CIL Work Plan: Houston CIL A Copy of the 704 Report (Parts I & II) Teleconference Evaluation Teleconference Audio Tape Order Form AGENDA Bob Michaels Welcome and Introduction John Nelson Overview of the 704 Report Purpose Identification of Parts Time Lines Question and Answers Kelly Buckland Part I: The SILC Report Questions and Answers Susan Webb Part II: The CIL Report Questions and Answers Bob Michaels Wrap-up and Adjournment TELECONFERENCE OBJECTIVES The following are goals and objectives for the IL NETWORK: NCIL/ILRU National Training and Technical Assistance Project teleconference on completing the 704 Report for both centers and state independent living councils. -- Provide an overview of the 704 report, its purposes, and background. -- Provide a brief review of demographic findings from the previous year's 704 report. -- Provide specific information on SILC reporting obligations. -- Provide specific information on CIL reporting obligations. -- Provide opportunity for asking questions of the presenters regarding specific issues. TELECONFERENCE PRESENTERS Bob Michaels Conference Moderator ILRU Program 65 E. Kelly Lane Tempe, AZ 85284 (602) 961-0553 Fax: 961-0533 DIMENET: michaels Kelly Buckland SILC Executive Director P.O. Box 83720 Boise, ID 83720 (208) 334-3800 TTY: 334-3803 Fax: 334-3803 DIMENET: idasilc John Nelson IL Branch Chief RSA 330 C Street, SW, Room 3326 Washington, DC 20202 (202) 205-9362 (V/TTY) Fax: 205-9772 DIMENET: jnelson Susan Webb Executive Director Arizona Bridge to Independent Living 1229 East Washington Street Phoenix, AZ 85034 (602) 256-2245 (V/TTY) Fax: 254-6407 DIMENET: abil IL NETWORK STAFF NCIL Anne-Marie Hughey Co-Director, IL NETWORK Dawn Kemp-Moye Whipple Dutton 2111 Wilson Blvd., Suite 405 Arlington, VA 22201 (703) 525-3406 TTY: 525-3407 Fax: 525-3409 DIMENET: hughey ILRU Program Laurel Richards Co-Director, IL NETWORK Quentin Smith Cynthia Dresden Dawn Heinsohn 2323 S. Shepherd, Suite 1000 Houston, TX 77019 (713) 520-0232 TTY: 520-5136 Fax: 520-5785 DIMENET: ilru Bob Michaels June Kailes Roland Sykes President GIMP/DIMENET 6256 Ramblewood Drive Dayton, OH 45424 513-237-8360 CONFERENCE CONSULTANT Jim Hollahan Organizational Development for Systems Serving Persons with Disabilities 8124 Hartford Ave. Silver Spring, MD 20910 (301) 565-0201 Fax: 565-0671 e-mail: Hollahan@aol.com ABOUT THE PRESENTERS BOB MICHAELS is co-director of curriculum development and training with the IL NETWORK and is training and technical assistance associate with ILRU. Before assuming his position with ILRU, Michaels was president and chief executive officer of Liberty Resources, Inc., in Philadelphia for four years. Prior to that, he served as director of the Arizona Bridge to Independent Living in Phoenix, and on both the Arizona and Pennsylvania state independent living councils. He has been chair of the Rehab Act Subcommittee for the National Council on Independent Living (NCIL) for the past ten years. JOHN NELSON is chief of the Independent Living Branch, Rehabilitation Services Administration (RSA). Previously, he acted as special assistant to the commissioner of RSA as well as chief of administrative management services at RSA. One of the most influential shapers of the Title VII regulations for the amended Rehab Act (1992) and the recently approved standards and indicators of compliance for independent living centers, Nelson has been a strong presence in the progress for independence and empowerment of people with disabilities. His efforts within the legislative process have ensured that the regulations in place today reflect to the largest degree possible the interests and philosophy of independent living. KELLY BUCKLAND currently serves as executive director of the Idaho state independent living council (SILC) and is former chair of the SILC. As co-founder of the Idaho Task Force on the Americans with Disabilities Act and executive director of the Living Independence Network Corporation, Boise, Idaho, he has been actively involved with the direct service and systemic change aspects of the independent living movement. Over the past decade, Buckland has worked closely with the Idaho state legislature on issues affecting people with disabilities, including passage of the Personal Care Services bill. SUSAN WEBB has been the executive director of the Arizona Bridge to Independent Living (ABIL) for four years. Prior to joining ABIL, Webb was a senior account executive at AT&T and served on the board of the U.S. Architectural and Transportation Barriers Compliance Board (ATBCB). She is a certified instructor in the Maricopa County Community College District and has guest lectured at the school of law, school of architecture, and communications department at Arizona State University. Webb has facilitated groups and hearings and has presented hundreds of speeches on disability rights and independent living philosophy across the country over the past 20 years. ABOUT NCIL Founded in 1982, the National Council on Independent Living is a membership organization representing independent living centers and individuals with disabilities. NCIL has been instrumental in efforts to standardize requirements for consumer control in management and delivery of services provided through federally-funded independent living centers. Until 1992, NCIL's efforts to foster consumer control and direction in independent living services through changes in federal legislation and regulations were coordinated through an extensive network and involvement of volunteers from independent living centers and other organizations around the country. Since 1992, NCIL has had a national office in Arlington, Virginia, just minutes by subway or car from the major centers of government in Washington, D.C. While NCIL continues to rely on the commitment and dedication of volunteers from around the country, the establishment of a national office with staff and other resources has strengthened its capacity to serve as the voice for independent living in matters of critical importance in eliminating discrimination and unequal treatment based on disability. Today, NCIL is a strong voice for independent living in our nation's capital. With your participation, NCIL can deliver the message of independent living to even more people who are charged with the important responsibility of making laws and creating programs designed to assure equal rights for all. ABOUT ILRU The Independent Living Research Utilization (ILRU) Program was established in 1977 to serve as a national center for information, training, research, and technical assistance for independent living. In the mid-1980's, it began conducting management training programs for executive directors and middle managers of independent living centers in the U.S. Since 1985, it has operated the ILRU Research and Training Center on Independent Living at TIRR, conducting a comprehensive and coordinated set of research, training, and technical assistance projects focusing on leading issues facing the independent living field. ILRU has developed an extensive set of resource materials on various aspects of independent living, including a comprehensive directory of programs providing independent living services in the U.S. and Canada. ILRU is a program of TIRR, a nationally recognized, free-standing rehabilitation facility for persons with physical disabilities. TIRR is part of TIRR Systems, a not-for-profit corporation dedicated to providing a continuum of services to individuals with disabilities. Since 1959, TIRR has provided patient care, education, and research to promote the integration of people with physical and cognitive disabilities into all aspects of community living. ABOUT THE IL NETWORK The IL NETWORK is a collaboration of the National Council on Independent Living (NCIL), the Independent Living Research Utilization (ILRU) Program, and several other organizations and individuals involved in independent living nationwide. The mission of the IL NETWORK is to provide training and technical assistance on a variety of issues central to independent living today--understanding the Rehab Act, what the statewide independent living council is and how it can operate most effectively, management issues for centers for independent living, and others. Training activities are conducted conference-style, via long-distance communication, through widely disseminated print and audio materials, and through promotion of a strong national network of centers and individuals in the independent living field. IL NETWORK goals include: -- conducting training on provisions of the recently amended Rehabilitation Act and on independent living center operations nationwide; -- establishing a technical assistance service through development of a network of individuals around the country who have expertise in various aspects of center operations and Title VII of the Rehab Act; -- identifying, adapting, and/or developing resource materials to support training and technical assistance activities related to the Rehab Act and center operations; -- using the DIMENET computer network to support training, technical assistance, and dissemination activities and promoting network development and information sharing among centers and other organizations involved in independent living; -- exploring the use of distance-learning technology in addressing the information, training, and technical assistance needs of the field; and -- fostering inclusion in the independent living field of people from various cultural and disability groups and geographic areas through activities carried out with NCIL's Multicultural Committee and the Association of Programs for Rural Independent Living (APRIL). IL NETWORK STAFF The IL NETWORK is managed by a directorate consisting of Anne-Marie Hughey of NCIL; June Isaacson Kailes, an independent living consultant; and Bob Michaels, Laurel Richards and Quentin Smith of ILRU. Principal responsibility for curriculum development and training is shared by Kailes and Michaels; logistical coordination by NCIL; materials development and technical assistance coordination by ILRU; and responsibility for information dissemination is shared between NCIL and ILRU. The IL NETWORK also works very closely with a number of individuals and organizations, particularly Roland Sykes of DIMENET, in fostering more effective computerized networking among centers, and Steve Brown, in evaluating project impact and identifying movement-wide factors which impede effective center operations. In addition, individuals with expertise on Title VII of the Rehab Act and on center operations will be involved throughout training and technical assistance activities. TRAINING ACTIVITIES During the first year, training programs were conducted in each of the ten federal regions and were attended by more than 600 representatives of independent living centers and SILCs. Year one training activities focused largely on the amended Rehab Act and its implications for independent living centers and statewide independent living councils. Issues related to center operations and to use of DIMENET as a networking and technical assistance tool were covered as well. Year two training and technical assistance activities emphasized the recently published compliance indicators for centers, critical issues related to statewide independent living councils and development of state IL plans, systems advocacy, computer networking, and a closer look at state-administered CILs in the seven "723" states. Most of these focal points were identified through training participants' input and technical assistance requests. In response to feedback from the field through the SILC and CIL 704 reports as well as to activities conducted during the previous two years, the curriculum for IL NETWORK programs during the upcoming year will center on building strong foundations for centers in a changing environment. Innovative techniques in center management, doing systems advocacy, meeting reporting requirements, and diversification of funding resources will be included among training topics. These issues and others will be covered through new and dynamic training methods--national teleconferences, customized training programs for SILCs, and training conferences held in diverse regions of the country. In addition, the IL NETWORK plans to convene a task force with representation by RSA central and regional offices, state voc rehab agencies, and independent living centers for the purpose of examining policies and procedures affecting center and agency interaction. TECHNICAL ASSISTANCE Requests for technical assistance, whether from center staff, board members, or others involved in independent activities, are handled through a single point of contact at ILRU. ILRU staff determines who among various partner organizations and individuals are the most qualified to respond to the request, then provides referral to one or more potential technical assistants who may be ILRU staff, NCIL staff or board members, or other members of the project's technical assistance network. During the first two project years, IL NETWORK staff responded to over 20,000 telephone requests from the field. IL NETWORK STAFF NCIL Anne-Marie Hughey Dawn Kemp-Moye Whipple Dutton (703) 525-3406 (V), 525-3409 (TTY), 525-3407 (Fax) ILRU Program Laurel Richards Bob Michaels (602) 961-0553 (V), 961-0533 (Fax) Quentin Smith Cynthia Dresden Dawn Heinsohn Laurie Gerken Redd (713) 520-0232 (V), 520-5136 (TTY), 520-5785 (Fax) June Isaacson Kailes (310) 821-7080 (V), 827-0269 (Fax) Steve Brown (505) 522-5225 (V/TTY/Fax) Roland Sykes (513) 237-8360 (V) IL NETWORK SUPPORT This three-year project is supported in part by the Rehabilitation Services Administration of the U.S. Department of Education, with additional support provided by NCIL, ILRU, DIMENET, and other project partners. INFORMATION RELATED TO THE 704 REPORT KEY DEMOGRAPHIC FINDINGS FROM THE 704 REPORTS Title VII, Part II: CILs From Year Ending 9/30/94 Funding sources: Federal government 39.95% Non-federal government 60.05% Decision-making staff : [N=845] Disability 65.60% Minority 18.10% Other staff: [N=2,027] Disability 65.05% Minority 23.12% Planning for CIL consumers: [N=43,916] Waived plan 20.08% Developed plan 79.92% Consumer age: [N=84,457] Under 6 0.47% 6-17 2.29% 18-22 3.54% 23-54 32.12% 55 and over 60.94% Consumer gender: [N=84,399] Female 52.73% Male 47.27% Consumer race/ethnicity: [N=88,579] White 64.33% Black 19.80% Hispanic 10.04% American Indian 2.11% Asian/Pacific Islander 2.45% Multi-cultural 1.27% Consumer disability: [N=95,651] Cognitive 9.35% Mental 8.14% Physical 45.08% Sensory 18.18% Multiple 19.25% PURPOSE OF THE 704 ANNUAL PERFORMANCE REPORT The purpose of the 704 report is to: Serve as a performance measuring instrument of independent living programs, both quantitatively and qualitatively; Determine the training and technical assistance needs of statewide independent living councils (SILCs) and centers for independent living (CILs) as required by section 721(b)(3) of the Act; Determine CIL compliance with the standards, assurances, and indicators of compliance with the standards in section 725 of the Act and 34 CFR Part 366; Collect information necessary for issuance of continuation awards for qualified CILs funded under the CIL program; Collect the data required by sections 13, 706, 721, and 725 of the Rehabilitation Act of 1973, as amended (Act) for the State Independent Living Services program and the Centers for Independent Living programs; Serve as the basis for on-site reviews of the Chapter 1, Title VII of the Act program grantees; and Obtain a report from SILCs and Designated State Units regarding their activities in the state plan for independent living development, administration, monitoring, and evaluation, including an assessment of consumer satisfaction with the IL programs in the States. From the RSA Policy Directive dated August 28, 1995 (RSA-PD-95-07, RSM-0501). KEY FEATURES OF THE 704 ANNUAL PERFORMANCE REPORT PART I (Statewide Independent Living Council Portion) Attachment I - D(a) - SILC Activities Attachment I - D(b) - Training and Technical Assistance Needs (SILC) Attachment I - F - Narrative--Jointly Submitted with DSU(s) PART II (Centers for Independent Living Portion) SUBPART IIA: Self Evaluation Compliance Indicator 1 - Philosophy II-3 I--Consumer Control II-3 II--Self-help and Self-advocacy II-3 III-- Development of Peer Relationships and Peer Role Models II-3 IV--Equal Access II-4 Compliance Indicator 2--Cross-Disability II-5 Compliance Indicator 3--Independent Living Goals II-5 Compliance Indicator 4--Community Options and Community Capacity II-6 Compliance Indicator 5--Independent Living Services II-6 Compliance Indicator 6--Resource Development Activities II-7 SUBPART IIB: Narrative - Comparison of the Activities of the CIL in Prior Years with the Activities in the Most Recent Year II-7 Attachment II - B-Narrative SUBPART IIC: Program and Financial Planning Objectives II-8 Attachment II - C(a) - Next Fiscal Year Work Plan Attachment II - C(b) - Technical Assistance and Training Needs (CIL) SUBPART IID: Sources and Amounts of Funding for the Operation of the CIL I - Resources II-9 SUBPART IIE: Next Fiscal Year Budget Information I - Form 524 II-11 SUBPART IIF: Numbers and Types of Individuals with Significant Disabilities Receiving Services through the CIL I - Consumers Served During Year II-13 II - CSRS Inactive @ Sept. 30 II-13 III - CRS Active @ Sept. 30 II-13 IV - Time CRS Active II-13 V - Consumer Achievements II-14 VI - Age II-14 VII - Gender II-14 VIII -Race/Ethnicity II-14 IX - Disability II-15 X - Living Arrangements CRS @ Sept. 30 II-15 XI - Source of Personal Assistance Services Reimbursement CRS @ Sept. 30 II-15 SUBPART IIG: Types of Services Provided through the CIL and the Number of Individuals with Significant Disabilities Receiving Each Type of Service I - Community Services - Total Hours II-16 II -Individual Services - No. of Persons Served II-16 SAMPLE 704 PERFORMANCE REPORT FOR SILCS IDAHO SILC: REPORT TO THE GOVERNOR May 28, 1993-June 30, 1994 The establishment of the State Independent Living Council (SILC). . . . Finally, the citizens affected by government programs will have a voice in the decisions that impact their lives. INTRODUCTION This first year has been one of tremendous growth and awareness for the members of the State Independent Living Council (SILC). The Council has been busy in attempting to fulfill its requirements under the law and to increasing the opportunity for people with disabilities to live independently. The SILC, since its inception, is actively engaged in activities that will assist consumers with disabilities to have a greater voice in obtaining services that are cost-effective, consumer-responsive and community-based. This report will provide you with an introduction to the SILC and to the Independent Living Philosophy which is at the heart of the Council's Mission Statement, Goals and Objectives. In addition, we will tell you who we are, the actions we have taken thus far and the vision we have for the future. We are pleased to report to you that Idaho is one of only a couple of states whose Councils have taken a lead in the Independent Living movement. We plan to continue this momentum during this next year with some ambitious goals and objectives as outlined in our one-year State Plan for Independent Living (SPIL). We welcome any comments, concerns or questions that you may have pertaining to this report or issues surrounding independent living. In the interests of people with disabilities, Kelly Buckland, Chair State Independent Living Council (SILC) BACKGROUND The Rehabilitation Act Amendments of 1992 was signed into law by President Bush on October 30, 1992. The passage of this Act represents a major victory for people with disabilities and Independent Living. One of the requirements of the new Act is that a State Independent Living Council be created. The Council was appointed by Governor Cecil D. Andrus, and created by Executive Order 93-01 on May 28, 1993. The State Independent Living Council's Mission Statement is as follows: The State Independent Living Council aspires to promote a philosophy of independent living, including a philosophy of consumer control, peer-support, self-help, self-determination, equal access, and individual and system advocacy, in order to maximize opportunities for individuals with disabilities, and the integration and full inclusion of individuals with disabilities into the mainstream of society. To better understand what lies at the heart of the Council, we must first define what is Independent Living. Most Americans take for granted opportunities they have regarding living arrangements, employment situation, means of transportation, social and recreational activities and other aspects of everyday life. For many Idahoans with disabilities, barriers in their communities take away or severely limit their choices. These barriers may be obvious, such as lack of ramped entrances for people who use wheelchairs, lack of interpreters or captioning for people with hearing impairments, lack of braille or taped copes of printed material for people who have visual impairments. Other barriers. . .frequently less obvious. . .can be even more limiting to efforts on the part of people with disabilities to live independently, and they result from people' misunderstandings and prejudices about disability. These barriers result in not only low expectations about things people with disabilities can achieve but also create a loss of power and autonomy for people with disabilities. This need not occur. People who experience disabilities have established lives of independence. They fulfill all kinds of roles in their communities. In most cases, the barriers society places in front of them haven't been removed, but these individuals have been successful in overcoming or at least dealing with them. Independent Living is essentially, living just like everyone else--having opportunities to make decisions that affect one's life, able to pursue activities of one's own choosing--limited only in the same ways that one's neighbors who do not have disabilities are limited. Independent living has to do with self-determination. It is having the right and the opportunity to pursue a course of action. And, it is freedom to fail and to learn from one's failures, just as people who do not have disabilities do. With this brief introduction and background, we want to tell you about the Council, it's makeup and what its responsibilities are. COUNCIL MEMBERSHIP Twenty-one individuals are appointed by the Governor to the SILC. These individuals must represent abroad range of disabilities and be knowledgeable about centers for independent living and independent living services. The Council must be made up of at least 51% with disabilities. The majority of the members can not be staff of Independent Living Centers (ILC) or State agencies. Each member of the SILC is appointed to a three-year term. The Council can not be part of any other state agency. Members of the SILC include: -- People with Disabilities-A majority of the SILC members are individuals with a disability. -- Parents of Children or Adults with Disabilities -- Advocates for People with Disabilities -- Independent Living Center Representatives -- Service Providers for People with Disabilities -- Business Representatives -- Non-Voting Members, including representatives from: -Idaho Division of Vocational Rehabilitation -Idaho Commission for the Blind and Visually Impaired -Department of Health & Welfare -Department of Education-Division of Special Education The consumers on the SILC represent a wide range of disabilities; mobility impairments, hearing impairments, blind and visually impaired, mental illness, mental retardation, cerebral palsy, asthma, multiple sclerosis, epilepsy, and polio. The Council also seeks representation of individuals with disabilities that are unserved, or underserved, including minority groups such as Hispanic and Native American and urban and rural populations. SILC RESPONSIBILITIES -- Advocate for independent living services provided through State and Federal programs for people with disabilities. Support centers for independent living. -- In cooperation with the Idaho Division of Vocational Rehabilitation and the Idaho Commission for the Blind and Visually Impaired, develop, sign and submit the State Plan for Independent Living Services (SPIL) for people with disabilities. Monitor, review and evaluate the implementation of the State Plan for Independent Living Services. -- Gather information , conduct studies and analyses, and develop model policies. Conduct training on the independent living philosophy and outreach to unserved or underserved populations. Carry out demonstrations to expand and improve independent living services and activities to improve current disability service systems. SILC FUNDING The SILC receives its funding through the Idaho Division of Vocational Rehabilitation and the Idaho Commission for the Blind and Visually Impaired in addition to General funds appropriated by the State Legislature. Fund sources for FY 95 are as follows: -- Federal Funds, $149,500 (89%) -- General Funds, $ 13,900 (8%) -- Other, $ 5,300 (3%) TOTAL: $168,700 CHRONOLOGICAL HIGHLIGHTS OF SILC ACTIVITIES -- First meeting of SILC held June 2, 1993 Provide information specific to CIL reporting obligations. Interim Chair, Kelly Buckland elected Bylaws Work Group formed Work started on FY 94 Interim State Plan -- Orientation and Training for SILC held July 20+21, 1993 Training conducted by Independent Living Consultant -- SILC Priorities established and Initial Committees formed during July 21, 1993 meeting -- During October 25, 1993 meeting; SILC Budget for FY95 reviewed Executive Committee consisting of Chair, Vice-Chair and Secretary created Budget Committee formed Bylaws Committee formed Personnel Committee combined with Budget Committee and Support Operations Representative from SILC to Idaho Vocational Rehabilitation Advisory Council identified -- SILC adopts SFY 94 and SFY 95 budgets negotiated with IDVR at December 3, 1993 meeting. DAC Satellite Office funding approved at $25,000. ICB/SILC Independent Living Plan accepted IDVR/SILC Independent Living Plan accepted Draft Bylaws reviewed Authorization given to SILC Chair to contract for two personnel through temporary agency-Rochelle Etychison hired as Secretary -- February 11, 1994 meeting prompted the following actions; SILC adopts IDVR regional alignment Standing Committees formalized Janette Lancaster elected Vice-Chair All SILC decisions will be made by simple majority vote Bylaws as amended, adopted -- SILC determines that office space for Council be located in Boise Kelly Buckland elected SILC Chair in March, 1994 SILC supports legislation affecting individuals with disabilities Michelle Keller and Jeananne Whitmer hired as Interim Executive Staff -- SILC activities occurring during April, 1994 included SILC sends letter to Governor requesting the State adopt a policy on prohibiting State agencies from conducting business with entities that are not in compliance with the ADA. Executive Committee membership expanded to include all Standing Committee Chairs Three new Council members recommended for appointment to SILC Three Council members recommended for reappointment to SILC Joe Karpach designated SILC liaison to IDVR Advisory Council Member-at-large position on SILC established RFP announced for Needs Assessment at $25,000 Council contracts with Maggie Shreve to conduct "Train the Trainers on Independent Living" and SILC member orientation -- In April, 1994 SILC staff move to permanent office located at 350 North 9th, Suite 610B, Boise, Idaho. -- In April, SILC Chair and Vice Chair attend National Council on Independent Living (NCIL) conference in Washington, D.C. -- In May, SILC Chair, Kelly Buckland, Planning Committee Chair, Mark Leeper and Interim Executive Staff , Michelle Keller attend Region X meeting of SILC Chairs, Independent Living Center Directors, and Council staff in Seattle to discuss the new regulations on the SPIL. Idaho's SILC is only state to have their draft FY95 SPIL developed, a permanent office located, furnished, and staff hired. -- During the June 10, 1994 meeting the following actions were noted; Council receives additional $7,600 from IDVR Staff report that Office has been furnished and computer equipment has been purchased. Vacant position on Council identified as needing to be Hispanic from Region 7 RFP Bid Openings for Needs Assessment rejected Draft FY95 State Plan for Independent Living Services (SPIL) reviewed Public Comment on SPIL scheduled -- FY95 State Plan for Independent Living Services (single plan) transmitted to Region X RSA for approval on June 21, 1994. The SILC achieved a major accomplishment this past year in its joint planning efforts with the IDVR and the ICBVI. It was able to reach agreement with the other designated state agencies (DSU's) that a single State Plan for Independent Living Services (SPIL) be developed for FY 95. The prior fiscal year's plan consisted of a "boiler plate" section addressing Federal assurances and two separate sections excerpted from the IDVR and ICBVI state plans. This plan did not present a unified picture of independent living within the State. The Planning Committee, chaired by Mark Leeper, Moscow, ID worked within short time frames and often confusing Federal guidelines to be able to submit a state plan to RSA Region X well in advance of the June 30, 1994 deadline. Idaho was the only state in Region X to have a draft SPIL developed at the time SILC members were in attendance at a Region X planning meeting in May 1994. This draft was made available to the other state SILC's as a guide of what a "single state plan" might look like. This accomplishment of a unified state plan for independent living services now gives the SILC, the IDVR and ICBVI an opportunity to focus on issues and projects of major importance to persons with disabilities in Idaho. During its plan development process in 1995, the SILC will be developing its first three-year plan. The SILC wishes to thank the following individuals who provided program insight, fiscal and planning technical assistance in the development of the FY 95 State Plan for Independent Living Services: SILC Planning Committee Mark Leeper, Chair Dale Hasenoehrl Terry Hawley Kyle Packer SILC Members Kelly Buckland, Chair Janette Lancaster, Vice Chair Blaine Edmo Dana Gover Blenda Davis Roger Howard Kathy Combo Joe Karpach Mike Prokopp Todd DeVries Eric Cooney Elizabeth "Becky" Rawson Caroline Campbell Sharon Pond Paul Swatsenbarg Dana Ard Idaho Division of Vocational Rehabilitation George J. Pelletier, Jr., Administrator Richard L. Sloneker, Supervisor, Fiscal Operations Marylss Meyer, Specialist Idaho Commission for the Blind and Visually Impaired Edward J. McHugh, Administrator Mike Blackaller, Chief, Rehabilitation Services Mary Kyle, Information Specialist SILC Staff (as of December 1, 1994) Jeananne Whitmer Linda Vaniman During this coming FY, the SILC will be providing training on independent living, conducting a needs assessment, networking , supporting legislation on behalf of persons with disabilities, developing a three-year state plan, expanding its operational capabilities with a request for additional staff , and supporting the expansion of centers for independent living into unserved and underserved areas of the State. It is the SILC's intent to continue to be a leader among the other state SILC's in continuing to promote the independent living philosophy and in the approaches it seeks to meet the challenges of persons with disabilities. IDAHO STATE INDEPENDENT LIVING COUNCIL JUNE 1994 KELLY BUCKLAND, CHAIRMAN, BOISE JANETTE LANCASTER, VICE CHAIRMAN, TWIN FALLS DANA ARD, ICBVI, BOISE CAROLINE CAMPBELL, IDAHO FALLS KATHY COMBO, BOISE ERIC COONEY, BOISE BLENDA DAVIS, BOISE TODD DEVRIES, MOSCOW BLAINE EDMO, FORT HALL DANA GOVER, BOISE DALE HASENOEHRL, IDVR, LEWISTON TERRY HAWLEY, BLACKFOOT ROGER HOWARD, BOISE JOE KARPACH, BOISE MARK LEEPER, MOSCOW KYLE PACKER, POCATELLO, SHARON POND, SPECIAL ED., BOISE MIKE PROKOP, COEUR d'ALENE BECKY RAWSON, CHUBBUCK PAUL SWATSENBARG, DHW, BOISE SILC STAFF JEANANNE WHITMER LINDA VANIMAN SAMPLE 704 PERFORMANCE REPORT: IDAHO SILC Attachment I-D(a) - SILC Activities -- First meeting of SILC held on June 2, 1993. Interim Chair elected Bylaws work group formed Work started on FY 1994 State Plan -- Orientation and Training for SILC held July 20-21, 1993. -- SILC Priorities established. Initial committees formed during July 21, 1993, meeting -- During October 25, 1993, meeting: SILC Budget for FY 1995 reviewed Executive Committee consisting of Chair, Vice-Chair and Secretary created Budget Committee formed Bylaws Committee formed Personnel Committee combined with Budget Committee and Support Operations Representative from SILC to Idaho Vocational Rehabilitation Advisory Council identified -- SILC adopts FY 1994 and FY 1995 budgets negotiated with IDVR at December 3, 1993, meeting. DAC-NW Satellite Office funding approved at $25,000 ICBVI/SILC Independent Living Plan accepted IDVR/SILC Independent Living Plan accepted Draft Bylaws reviewed Authorization given to SILC Chair to contract for two employees through temporary agency -- February 11, 1994, meeting prompted the following actions: SILC adopts IDVR regional alignment Standing Committees formalized Vice-Chair is elected All SILC decisions will be made by simple majority vote Bylaws as amended, adopted SILC determines that office for Council should be located in Boise -- SILC Chair is elected in March 1994. SILC supports legislation affecting individuals with disabilities Interim Executive Staff is hired Attachment I-D(a) SILC Activities Page 1 of 5 Attachment I-D(a) - SILC Activities (continued) -- SILC activities occurring during April 1994 included: SILC sends letter to Governor requesting the State adopt a policy prohibiting State agencies from conducting business with entities not in compliance with ADA Executive Committee membership expanded to include all Standing Committee Chairs Three new Council members recommended for appointment to SILC Three Council members recommended for reappointment to SILC SILC liaison to IDVR Advisory Council designated Member-at-Large position on SILC established RFP announced for Needs Assessment at $25,000 Council contracts with a consultant to conduct "Train the Trainers on Independent Living" and SILC member orientation -- In April 1994, SILC staff move to permanent office located at 350 N. 9th, Suite 610B, Boise. SILC Chair and Vice-Chair attend National Council on Independent Living (NCIL) conference in Washington, D.C. -- In May, the SILC Chair, Planning Committee Chair and Interim Executive Staff attend Region X meeting of SILC Chairs, Independent Living Center Directors, and Council staffs in Seattle to discuss the new regulations on the State Plan for Independent Living (SPIL). Idaho's is the only SILC to have its draft FY 1995 SPIL developed, a permanent office located and furnished, and staff hired. -- During the June 1994 meeting, the following actions were noted: Council receives additional $7,600 from IDVR Staff reports the office has been furnished and computer equipment purchased Vacant position on Council identified as Hispanic, Region 7 RFP bids for Needs Assessment rejected Draft FY 1995 State Plan for Independent Living Services (SPIL) reviewed Public Comment on SPIL scheduled FY 1995 State Plan for Independent Living Services (single plan) transmitted to Region X RSA for approval on June 21, 1994 -- In August 1994: Committees instructed to develop those activities which may require funding under the SPIL Job description for the Executive Director of the SILC sent to the Personnel Commission 1996 budget request submitted to the Governor's Office -- In September a request was sent to State Agencies for assistance in conducting a statewide Needs Assessment. Attachment I-D(a) SILC Activities Page 2 of 5 Attachment I-D(a) - SILC Activities (continued) -- In September an agreement was developed with Boise State University to conduct a statewide Needs Assessment of 600 people with disabilities. To assure participation from under-served and unserved people with disabilities, the CILs have been included in the Needs Assessment design to provide the SILC with an additional 100 consumer participants. Solutions to Problems Encountered by the SILC The SILC was able to reach agreement with Idaho Commission for the Blind & Visually Impaired (ICBVI) by creating a single State Plan for Independent Living Services (SPIL). This unified Plan for independent living services now gives the SILC, IDVR, and ICBVI an opportunity to focus on issues and projects of major importance to all persons with disabilities in Idaho. During its plan development process in 1995, the SILC will be working with the State Agencies in developing its first Three-Year Plan. Development and Implementation of the Design for the CIL Network The SILC placed a high priory on the support and development of CILs in the SPIL and identified funding resources. To this end, the SILC funded the Disability Action Center-Northwest efforts to create independent living services in the Panhandle of Idaho in FY 1994. The SILC, in a Three-Year Planning session, will review the goals and objectives relating the development and support of CILs in the interim plan with the anticipation of moving some of these activities into the future vision of the SILC. Finally, the SILC has become involved with the Idaho Coalition of Independent Living Centers (ICILC) towards the development of an effort to acquire State funding for the existing Centers. The SILC anticipates working with ICILC in developing a resolution which will be introduced in the 1995 legislative session, providing members of the Legislature with information and education regarding the benefits of independent living services available through Centers. The SILC projects that this effort will involve the participation IDVR, ICBVI, the Idaho State Council on Developmental Disabilities, and non-profit organizations providing services to people with disabilities. Evaluation and Monitoring Activities Conducted by or Participated in by the SILC During the first year, the Council has been engaged in implementing the requirements of the Act. The SILC, since its inception, has actively engaged in activities that will assist consumers with disabilities in having a greater voice in obtaining services that are cost-effective, consumer-responsive and community-based. Attachment I-D(a) SILC Activities Page 3 of 5 Attachment I-D(a) - SILC Activities (continued) The Act requires that a State Independent Living Council be created. The Council was appointed by Governor Cecil D. Andrus, and created by Executive order 93-01 on May 28, 1993. the State Independent Living Council's mission statement is as follows: The SILC advocates for equal opportunity, equal access, self-determination, independence, and choice for people with disabilities by: Promoting activities to improve and expand the disability service system; Reaching out to unserved and under-served and minority populations; Providing education and training on disability issues; Supporting projects that expand and improve Independent Living services; and Conducting studies and research to assist in developing model policies and recommendations for independent living in the State of Idaho. Legislative Activity of the SILC During the legislative session of 1994, the SILC was involved with legislation relating to accessible parking, tax credits for people with developmental disabilities, and fair housing. The SILC went on the record as proposing that the tax credit be extended to all people with disabilities, as described in the ADA. The SILC also supported legislation which would incorporate the Fair Housing Act into State law. SILC members agreed that the various State councils should communicate in the future when developing legislation. The SILC contacted the Idaho State Council on Developmental Disabilities expressing an interest in coordinating further legislative activities. Proposed Rule Making on Standards for CILs The SILC reviewed all CIL annual reports statewide. The SILC also provided comment on the proposed standards for Centers for Independent Living. Vocational Rehabilitation State Advisory Council (SAC) In order to better represents its interests, the SILC has formally become a member of the SAC. The SILC provided input to the State Vocational Rehabilitation Strategic Plan. The SILC continues to coordinate with SAC on other activities. National Council on Independent Living Conference The SILC Chair and Vice-Chair attended the National Council on Independent Living (NCIL) Conference in Washington D.C., on April 29 - May 3, 1994. The SILC felt a strong need to represent its interests in that the decision had not been made by RSA to require one state plan. At Attachment I-D(a) SILC Activities Page 4 of 5 Attachment I-D(a) - SILC Activities (continued) the time, RSA was also debating whether or not the SILCs would need to develop and submit Three-Year Plans as required by the Act. The Conference was well-attended, with 400 - 500 people taking part. Much of the material presented at the Conference pertained to health care reform and information relating to SILCs. Many NCIL members expressed frustration regarding their states' lack of progress in getting SILCs up and running; only 15 of 50 states have Councils established. For example, in New Jersey, there has been opposition to establishing another state council. Idaho's SILC is ahead of the other states. Region X Independent Living Meeting The Region X Independent Living Meeting was held in Seattle on May 18-19, 1994. John Nelson, the Director of Independent Living Programs from Washington, D.C., was in attendance to inform SILCs about state plan requirements. At the time, Idaho was ahead of other states in SILC development and planning. Other states were struggling to advance and to obtain funding for their Councils. National Federation of the Blind (NFB) Conference The SILC provided information on its formation to the NFB Conference. During this meeting, the NFB expressed its concern regarding under-representation of the blind on the SILC. The SILC continues to address this issue and believes that it must represent cross-disability groups as stated in the Act. Letter to the Governor Relating to Accessibility of State Meetings A letter was sent to Governor Andrus on May 25, 1994, requesting that a State policy be created providing that no State business will be conducted with entities that continue to do business while out of compliance with the Americans with Disabilities Act (ADA). In his response, received and reviewed by the Executive Committee, the Governor stated that he will not create such a policy, as there are too many small rural towns in Idaho which do not have accessible facilities and are unable to comply with the ADA. The SILC will continue to work with the Governor's Office to provide information and education on the importance of the State's compliance with the ADA. The consensus was that a new letter should ask the Governor to reconsider the issue and perhaps create a policy that requires agencies to make an attempt to find an ADA-compliant facility prior to scheduling meetings elsewhere. Attachment I-D(a) SILC Activities Page 5 of 5 Attachment I-D(b) - Training and Technical Assistance Needs The Idaho SILC provided training to members through the efforts of a consultant in November 1993 and again in October 1994. The Council anticipates a need to develop a training component on the background and history of independent living to new members as they are appointed to the SILC. To this end, the last training conducted by the SILC was captured on videotape with the intent of developing a training exercise for inclusion in the orientation program for all new Council members. The Idaho Interim Plan outlined technical assistance activities as they relate to under-served and unserved populations and minorities including American Indians, Spanish-speaking, and Asian people with disabilities. The SILC believes that training and technical assistance are essential in order to capture resources that will assist in the expansion of independent living services. The following activities prioritize and highlight Idaho's specific technical assistance needs: To expand the number of existing CILs by one center into unserved or under-served areas of the state. To investigate and seek funding from Regional Rehabilitation Counselor Education Program (RCEP) to support the technical assistance training from the National Institute on Disability Rehabilitation and Research (NIDRR). NIDRR is a viable resource for potential funds that might be available to support programs for individuals who have been under-served in independent living. To investigate funding from the Office of Special Education and Rehabilitation (OSER) by requesting a visit from the Assistant Commissioner of OSER to provide information on the availability of funding and to receive technical assistance on the application process. To promote the development of strategies for individuals who are unserved (American Indians, Hispanic, etc.) in independent living programs by seeking training from entities with expertise, such as the Rural RTC in Missoula, Montana. Attachment I-D(b) Training and Technical Assistance Needs Page 1 of 1 EDITOR'S NOTE: The following I-A(b) was developed jointly by the Idaho DSU & SILC. Subpart II - Allocation of Funds Part B, Ch. 1 Funds The SILC receives its funding through the Idaho Division of Vocational Rehabilitation (IDVR) and the Idaho Commission for the Blind and Visually Impaired (ICBVI) in addition to general funds appropriated by the State Legislature. Funding sources identified in Subpart IA- Administrative Data. Subpart II(d) - Support the General Operation of the CILs The support of operations of the CILs in Idaho is a high priority for the SILC. During FY 1993-94, the SILC awarded a contract to the Disability Action Center-Northwest (DAC-NW) (Moscow) to develop the core independent living services, increase community options for people with disabilities and to provide opportunities for increasing the service systems capacity for serving people with disabilities. DAC-NW, in its contract with the SILC, will continue to provide core services in an unserved area of Idaho, increase consumer involvement in decision-making and operation of the center, hosting at least two basic training sessions on independent living, and creating a regional (state) activity that will create a plan for the expansion of the independent living philosophy. Subpart II(e) - Support Activities to Increase Capacity for Providing IL Services The Outreach Committee engaged the services of Menzel-Higgins Communications, a public relations firm, to develop a promotional campaign for the SILC. The contract was developed to provide the SILC with the specific goal of providing assistance in developing a mission statement for the SILC. In addition to this contract, the SILC staff has been working with a television station in Idaho Falls on the production of a Public Service Announcement (PSA). The PSA will include recreational and employment location stills, a voice-over by Kirk Kilgore, and music by Marshall Tucker. The PSA is in line with the mission statement of the SILC, with an emphasis on empowerment and vision rather than SILC as a service organization. As soon as the PSA is completed, copies will be disseminated for viewing prior to its being sent out statewide. Subpart II(f) - Conduct Studies and Analyses to Enhance IL Services To assist in the development of the Three-Year Plan, the SILC awarded a contract to Boise State University (BSU) for the purpose of conducting a statewide Needs Assessment. Specifically, the SILC is developing and implementing a statewide survey of independent living needs of people with disabilities in Idaho. Attachment I-A(b) Grants and Contracts Page 1 of 3 Subpart II(f) - Conduct Studies and Analyses to Enhance IL Services (continued) The survey in addition to assessing the independent living needs of people with disabilities, must also reflect the specific needs of unserved and under-served people with disabilities. For example, the specific independent living needs of Native Americans, Hispanics, Asians, and specific service needs of different disability groups, e.g., people with head injuries, the blind, deaf, and hard-of-hearing. The SILC is contracting with BSU for the purpose of conducting a telephone survey of 600 consumers to assess the independent living needs of people with disabilities in Idaho. BSU will work closely with the SILC Program Committee to develop the survey instrument to be administered. BSU will be responsible for tabulating the results from the telephone interviews and presenting these results in the form a report of recommendations for independent living services in Idaho. The survey report is due January 15, 1995, and will contain at a minimum: Introduction: The SILC's reason for conducting the Needs Assessment in the target area and background on that area. Purpose: The report by the Consultant will contain observations and trends gathered by the survey in the target area (Regions). Recommendations: The report by the Consultant will provide the SILC with recommendations to be used by the SILC in the public forum process to be conducted by the SILC. Subpart II(g) - Train Regarding IL Philosophy The SILC awarded a contract to Maggie Shreve, organization Development consultant, to present a two and one-half day training on Independent Living. The first half-day of the training provided a comprehensive overview of the history and philosophy of the independent living movement to SILC members. The following two days were open to consumers from around the state. The training was offered to prepare the trainees for teaching the principles of independent living and developing strategies in their home communities. The training helped the participants to: -- develop an idea of what independent living would be like in the state of Idaho and its respective regions under ideal conditions; -- determine the obstacles which block this vision from becoming a reality in the respective regions; Attachment I-A(b) Grants and Contracts Page 2 of 3 Subpart II(h) - Provide Outreach to Unserved or Under-served Populations (continued) -- organize individuals with disabilities around common strategies to begin eliminating obstacles and support implementation of statewide plans; and -- train individuals with disabilities to facilitate additional meetings and organize other types of events. Subpart II(h) - Provide Outreach to Unserved or Under-served Populations The SILC awarded funding to each of the Centers for Independent Living: Disability Action Center-Northwest, Living Independence Network Corporation, Access for Idaho, and Eastern Idaho Center for Independent Living, for the purpose of hosting a series of town meetings to gather information on the independent living needs of unserved or under-served populations, including minority groups and urban and rural populations. The SILC is anticipating that the results from the Needs Assessment, goals and objectives from the SILC's planning session, and information gained from these focus groups will provide comprehensive information for the Three-Year Plan. Attachment I-A(b) Grants and Contracts Page 3 of 3 SAMPLE 704 PERFORMANCE REPORT FOR CILS SAMPLE CIL PROGRAM NARRATIVE: ARIZONA BRIDGE TO INDEPENDENT LIVING SUBPART IIB: PROGRAM NARRATIVE Attachment II-B Submitted by Arizona Bridge to Independent Living August 1995 (a) A comparison of activities and accomplishments during the reporting year with the goals and activities included in the reporting year's work plan. Response: In the Continuation application narrative for Federal FY 93-94 the process being used by RSA at that time was focused on completed program activities and did not request a "work plan". Therefore, the comparison of ABIL's activities relative to ABIL's "plan" cannot be drawn from the application itself. The information provided in this narrative will delineate the goals and objectives developed in ABIL's Board/staff planning meeting held each May. As our fiscal year is July 1 through June 30, the one-year strategic plan we develop is not coincident with the Federal fiscal year. Hopefully in future years the reporting requirements requested for Part C-funded CILs will be consistent from year to year thereby allowing CILs to accumulate information throughout the year in a manner that allows more accurate reporting capability. ABIL's goals included: 1. Evaluate and improve, as needed, the quality of Community Integration programs to meet consumer requests. 2. Continue to seek additional funding from a variety of sources, including private funders, to increase availability of community integration services, especially early intervention peer support. 3. Evaluate in more detail the continuation of a temporary placement service for individuals with disabilities who have employment goals. 4. Increase the number of peer mentor trainings and subsequently the number of peer mentors in our program. 5. Continue to increase systems advocacy through collaboration with other community based disability organizations. 6. Establish a rural/minority outreach program designed to increase self-advocacy in these communities. 7. Refine our accounting procedures to include a mechanized program-accounting system. 8. Investigate expansion of ABIL's facilities to provide more space for new programs. (1) Advocacy (I) Community Advocacy Plan In the previous reporting year ABIL was part of a steering committee in collaboration with the Governor's Council on Developmental Disabilities Legislative Consortium and the Arizona Attorney General to secure passage of a State ADA (Arizonans with Disabilities Act) to provide for State enforcement of the same civil rights guaranteed by the Americans with Disabilities Act of 1990. The State ADA was signed into law during the previous year. During the current reporting year, ABIL continued to provide systems advocacy by serving on the Attorney General's Technical Advisory Committee to develop the rules for implementation at the State level. Hundreds of hours of technical assistance were provided for this effort. The draft rules were completed in October. In addition to the State ADA, ABIL initiated a project to change Motor Vehicle Division licensing rules and policies that were shown to discriminate against applicants with disabilities renewing their driver's license. This effort involved organizing and mobilizing 41 consumers and disability representatives to convince the MVD that the rules need changing. The rulemaking on this project continues at this time. However, much progress has been made including the development of a training video featuring several of the committee members that will be used to train field examiners on the appropriate method to evaluate individuals with disabilities. In collaboration with the Governor's Office on Americans with Disabilities, ABIL helped secure changes in the State process for employing and accommodating applicants with disabilities. Forms, policies and rules were changed to be consistent with the ADA. ABIL took a lead role in advocating for healthcare reform. We joined a coalition of Arizona organizations to promote a healthcare system that ensures access to appropriate healthcare for all Americans including those with disabilities. In addition to our local coalition efforts, we participated in the July, 1994 March on the Nation's Capitol after attending the White House celebration of the fourth anniversary of the ADA hosted by President and First Lady Clinton. Although systems advocacy is always a key component of ABIL's work plan, a major difference during this reporting year and the previous years is a decision made my our board to focus more efforts on collaborating with other organizations rather than "going it alone." This strategy has proven to be particularly successful and effective. However, our mandate to provide systems advocacy is critical in giving us the "credibility" to mobilize the community and take the lead on initiating activities. (ii) Technical Assistance Plan ABIL continues to receive thousands of calls for information and referral each year on such topics as accessible housing, transportation and public accommodations. ABIL maintains an I&R database that is continually updated to provide comprehensive and timely information. ABIL is the Arizona coordinator for the Pacific Disability and Technical Assistance Center. We have provided ADA training statewide, handling hundreds of calls from consumers, architects, businesses, public services and others on all aspects of the ADA, Fair Housing Amendments Act, Air Carrier Access Act, Social Security Work Incentives Act, Individuals with Disabilities Education Act and others. ABIL sends out hundreds of materials each year on the ADA and Fair Housing as well as product information on assistive technology and other community resources. This reporting year, we initiated a project with the assistance of an intern from Arizona State University to do a comprehensive survey of all multifamily housing in the greater Phoenix area to develop a report on the availability and types of accessible housing available. ABIL continued this reporting year to provide accredited courses on all aspects of the ADA through Gateway Community College. This year we were able to provide several scholarships sponsored by the Pacific DBTAC to students with disabilities to become fully trained on the ADA. (iii) Communication, coordination, and cooperation (collaboration plan). As mentioned earlier, ABIL's board of directors developed a policy to coordinate our systems advocacy efforts in collaboration with other disability organizations. We have successfully achieved relationships with numerous organizations including Arizona Paralyzed Veterans, Pilot Parent Partnerships, Easter Seals, Governor's Office on Americans with Disabilities, Valley Center for the Deaf, Arizona Center for Law in the Public Interest, Goodwill Industries, Governor's Council on Developmental Disabilities, New Horizons Community Services in Prescott, Mohave County ADA Office and numerous others. In addition to our collaborative efforts for systems advocacy, we developed a collaborative arrangement with Kelly Services, TAD Temporaries, Western Personnel, Staff One/Staff Temps, Stivers Personnel and others to develop a new program to place qualified individuals with disabilities into integrated, competitive employment. This collaboration enabled us to implement a temporary placement service using the business plan we developed during the last reporting year. (iv) Affirmative Action Plan ABIL's affirmative action activities included the formation of a Native American Advisory Committee. 35-50% of the individuals served in our early intervention peer support program are from minority groups. We noticed that many are Native Americans brought to Phoenix rehab units from the reservations. We recognized that these individuals are not only taken far from their homes, families and culture, they are thrust into a completely foreign medical system. With the assistance of the Institute for Human Development at Northern Arizona University we were able to begin identifying individuals who would be helpful in this program. We have identified a list of 87 organizations that represent minority groups. Each time we have a staff opening, the job announcement is sent to all of these agencies. We continue to have difficulty finding qualified individuals with disabilities who also are members of minority groups. We have not made much progress in this area. We continue to look not only for qualified staff but board members as well. Overall, in terms of the ethnic mix of consumers we serve our total statistical results are consistent with the general population in our service area. (2) Outreach ABIL's outreach continues to be exceptional. This year we were fortunate to collaborate with On-A-Roll Inc. to sponsor a weekly radio show on life with disability and the independent living movement. In addition to sponsoring the show we have been a frequent guest and actually hosted or co-hosted the show on several occasions. Salt River Project (a public utility) provided the resources to develop a 13-minute video tape on ABIL's programs and services. The tape is being used in community presentations by all staff, board and our 40 peer mentors. Salt River Project also produced a video public service announcement that is being shown on all of the Phoenix TV stations to promote our employment program. To date it has been shown hundreds of times and we continue to receive numerous calls per week from applicants to our program. ABIL publishes a monthly newsletter, THE BRIDGE, that is sent to over 3,000 individuals and organizations. The newsletter includes a calendar of events sponsored each month at our center including IL skills courses, advocacy courses, support groups, social/recreational activities and community activities (hearings, policy meetings, etc.) Each year ABIL participates in several trade shows and job fairs. Included are the Disability Expo; Reach Out, Speak Out, Sign Out; the ARA/RSA Annual Conference; the Phoenix Mayor's Committee on Employment of People with Disabilities Awards Luncheon; etc. This year ABIL provided a fulltime staff position to conduct rural/minority outreach to all of Central and Northern Arizona. We developed relationships in numerous rural communities. In collaboration with the Statewide Independent Living Council, ABIL provided ADA and Independent Living Philosophy workshops in Bullhead City, Kingman, Prescott, Show Low and Flagstaff. Additional outreach activities included: - Weekly IL presentations by our peer mentor teams to newly disabled individuals at all the major rehab centers. - Worked with New Horizons Community Services in Prescott to develop the structure for a new IL Center there. - Provided ongoing training to Goodwill Industries job developers and supervisors. - Continued to conduct workshops and speaking engagements across our service area to disability and non-disability related groups. - Continued to be a regular resource to all media on disability related issues. - Participated in the Arizona Telecommuting Advisory Council to promote telecommuting as a possible option to occasionally accommodate the needs of employees with episodic disabilities, including chemical sensitivity. We were featured in a video produced by the states of Arizona, Oregon and Washington. - Participated in a video distributed nationally by the National Park Service on accessibility to historic buildings. (3) Community and individual IL service needs In addition to the core services, ABIL implemented a program during the reporting year to reduce the unemployment rate of persons with disabilities. EmployABIL places qualified individuals with disabilities into community-based, competitive, integrated temporary jobs. ABIL continued to provide home modifications under contract with the City of Phoenix Community Development Block Grant program. This reporting year ABIL received a Targeted Care grant from Valley of the Sun United Way to expand our peer mentor program to include early intervention in medical rehab of newly disabled individuals. A fulltime staff position was allocated this year to conduct rural and minority outreach to identify IL needs. As a result we mentored a new IL center in Prescott to serve Northern Arizona, established a Native American Advisory Committee, doubled the number of trained peer mentor volunteers in our program, and initiated closer collaborative projects with other organizations serving people with disabilities. The majority of our consumer evaluation takes place by informal interviews, program success (consumer participation), phone surveys, written evaluations and consumer feedback at meetings. For example, in the Socialization through Recreation program, at many of the events staff will ask for verbal feedback about the activity and ask for suggestions for future activities. Then future activities are created with that feedback in mind. The home modification program is evaluated after projects are completed with phone interviews and written surveys. In addition, during FY 93-94 volunteers phoned consumers six months to one year after their modification to get feedback on ABIL services, e.g. independent living skills instruction. Attendant care trainees completed written evaluations. Participants in the ADA trainings in rural communities were asked to complete written evaluations. Approximately 140 phone surveys and 220 written evaluations were completed. ABIL chose not to include a survey in our newsletters because of low return rate in the past. (4) Not applicable (5) In FY 93-94 Title VII funding (including Part B and Part C) represented 43% of ABIL's funding. This does not include funding for our attendant services program as that program ended during the year. This figure also does not include in-kind contributions or volunteer time. (b) ABIL's work plan is qualitative rather than quantitative. Numerical data on goals, number of consumers served, ethnicity, etc. is kept and is reported in Section IIF and IIG of this report. (c) ABIL is the only ILC currently operating an employment program that places qualified individuals with disabilities into community-based, competitive temporary employment. The program is being documented for dissemination to all ILCs interested in receiving the information. (e) ABIL is fully supportive of the standards and compliance indicators. We are not experiencing any difficulty complying. SAMPLE CIL WORK PLAN: ARIZONA BRIDGE TO INDEPENDENT LIVING ATTACHMENT II - C(a) - CIL WORK PLAN (1) Goals and Activities ABIL meets all of the requirements of section 725 of the Act. Therefore, our long range goals are consistent with the Act. COMPLIANCE INDICATOR 1--PHILOSOPHY (a) Consumer Control (1) ABIL's governing board membership includes more than 50% individuals with significant disabilities. Our plan includes greater outreach to ethnic minority groups. Phoenix has an organization called "Black Board of Directors". Our board is currently pursuing them for possible qualified members. We also are looking for board members from our rural communities. ABIL currently meets the standards for number of employees with significant disabilities in decisionmaking positions. We continue to outreach to minority groups each time an opening is available. Our management staff turnover, however, is very low. (b) Self-help and self-advocacy ABIL offers self-advocacy courses for consumers at least monthly. Our plan is to continue to increase the number of individuals receiving this training. Additionally, we provide ongoing training in community advocacy issues monthly to our peer mentor teams. We have requested additional funding from United Way to fund our early intervention program in the rehab centers. Currently we receive some funding for this effort from them under the Targeted Care category. However, we have applied to become a United Way agency. If accepted this would increase our available funding for early intervention in the rehab centers threefold. We expect to know the results of our application this fall. (c) Development of peer relationships and peer role models ABIL currently maintains a pool of 40 trained peer mentor volunteers who provide peer mentoring in several different categories. Our current plan is to expand the program to focus a team specifically on peer mentoring for individuals with developmental disabilities. Our needs assessments from participating in DD workgroups indicates that peer support is a key component missing in the options available to this group. We have submitted a proposal to develop such a program. There will be an RFP issued by the Division for which ABIL will compete. ABIL has worked with the Area Agency on Aging to develop a proposal to provide ombudsman peer support in nursing homes and extended care facilities to mentor individuals who are "stuck" there. This is in addition to a task force of approximately 30 consumers we are facilitating who are either living in nursing homes or have lived there who are providing mentoring to each other to explore more independent options through systems change. (d) Equal Access (1) ABIL routinely provides interpreter services and all print materials in large print, Braille, cassette or disk. Our facility is fully accessible to individuals with all types of disabilities. We recently built an addition to our existing facilities which included two fully accessible unisex toilet rooms. We installed power assisted doors on both of our main restrooms. We have a van on-line with three wheelchair positions that is used to transport consumers and peer mentors to various ABIL activities. Not only do we ensure that any location at which we sponsor activities is accessible, it is our policy to refuse to participate in events that are not in accessible facilities. We were informed that the fragrance dispensers in our restrooms were problematic for individuals with chemical sensitivities; these have been removed. During our recent renovation, we provided a list of environmentally safe products to our contractor and required it to be used in the construction. (2) ABIL continually advocates for and promotes equal access in the community. We are currently collaborating with the Center for Disability Law to strengthen these efforts. We provide technical assistance to consumers to assist them in advocating for community access in any way possible. This year's plan includes being part of the steering committee to change Arizona's employment discrimination statute to include people with mental disabilities. (3) All ABIL materials are available in all alternative formats. All videos shown are open captioned. ABIL collaborates with the Phoenix library to have materials provided in Braille. A computer-assisted notetaking system is now available through the library from ABIL's efforts so that individuals with hearing loss but who do not know sign are able to communicate. COMPLIANCE INDICATOR 2--PROVISION OF SERVICES ON A CROSS-DISABILITY BASIS (a) ABIL's statistics consistently demonstrate a wide variety of disability types being served. This year's plan includes more outreach to individuals with developmental disabilities and people with psychiatric disabilities. Our goal is to strengthen cross referrals to specializing agencies when it makes sense to do so. For example, our employment program places individuals regardless of type of disability. However, if a blind individual, for example, needs mobility training, we will refer him/her to an agency that specializes in that type of service. (b) ABIL's statistics for serving people on a cross-disability basis are consistently diverse. This year's goal includes more outreach to rural communities to develop them further. We have developed "point" people in the rural communities. Our goal now is to assist those "point" people in the rural communities to further expand their peer mentoring efforts by providing them with technical assistance and training. (c) Core services are provided to people with a wide range of disability types. This year's plan includes an evaluation of how better to serve individuals with developmental disabilities and serious mental illness. COMPLIANCE INDICATOR 3--INDEPENDENT LIVING GOALS (a) ABIL staff is working with the SILC liaison to further refine ways to be consistent throughout the state on the format used for CSRs. ABIL has a database management system (Q&A) that maintains all consumer service records. The database is part of our local area network so all direct service staff have access to the CSRs. We are evaluating a new software package that is specifically designed for ILCs. At this time we are not sure of its portability with our other software and whether its cost can be justified. Our goal is to increase our consumer satisfaction assessments as part of the CSR package. As mentioned earlier, our goal is to increase the number of consumer satisfaction activities to ensure adequate data is collected to assess our programs. One of ABIL's main goals this year is to implement a "Continuous Quality Improvement Plan." This CQI Plan includes assessing consumer satisfaction with existing programs and conducted forums to gather information about programs we might need to develop. Recently two new board members were added who are long-time ABIL consumers. One of our goals for this year is to ask them to participate as observers in all ABIL programs and provide feedback as to their effectiveness. COMPLIANCE INDICATOR 4--COMMUNITY OPTIONS AND COMMUNITY CAPACITY. (a) (b) Community advocacy and technical assistance. This year ABIL plans to consistently provide support and take initiative where needed relative to removal of barriers (attitudinal, structural, operational) as we have always done. Our plans this year involve numerous community issues: 1) Changing state law to protect individuals with mental disabilities from employment discrimination; 2) promote independent living through home and community based services instead of nursing homes and group living arrangements; 3) advocate for improved healthcare coverage so that scarce IL dollars are not being used for medical services such as durable medical equipment and speech therapy; 4) continue marketing to the private sector about employment of individuals with disabilities; 5) continue to involve consumers/peer mentors as experts in system change rather than paid staff speaking for them. (c) Public information and education. ABIL continues to expand our information and education activities. Much progress has been made in innovative ways to increase ABIL's visibility in the community through a more "exciting" newsletter, videos, PSA's and community involvement. This year's work plan will focus on more information and education dissemination in rural and minority communities. (d) ABIL's early intervention program is our best means to reach unserved and underserved consumers and their families. While our general outreach activities are targeted at a wider audience, our early intervention program specifically targets newly disabled individuals who have limited experience with disability issues, regardless of their ethnic background or type of disability. This year's plan will focus more on outreach to people with developmental disabilities and serious mental illness. (e) ABIL effectively collaborates with all other organizations serving individuals with disabilities. We also collaborate significantly with private employers through our EmployABIL program. This year's plan, however, targets more outreach and collaborative efforts with organizations that may not be familiar with IL philosophy and are still thinking in terms of a medical model. These groups include ASU School of Social Work, Arizona Dept of Special Education, and various medical organizations. COMPLIANCE INDICATOR 5--IL CORE SERVICES AND OTHER IL SERVICES (a)+ (b) ABIL provides all of the core services. This year's workplan will assess the effectiveness of our activities through customer satisfaction surveys and observation of service delivery methods by board members. This is part of our Continuous Quality Improvement Plan. COMPLIANCE INDICATOR 6--RESOURCE DEVELOPMENT ACTIVITIES (a)+(b) ABIL continually looks for other funding sources for new and existing programs. Our more recent approach has been to focus on what we want to accomplish and then looking for the funds rather than developing programs based on grant dollars advertised. Our workplan for this year focuses on development of private resources and program income from our employment program with less reliance on government sources. We are currently negotiating with United Way to become a United Way agency to expand our early intervention peer mentor program. (2) Advocacy (I) Community Advocacy Plan This year's community advocacy plan includes the following activities: A. Facilitate a nursing home task force to strengthen the availability of personal assistance services and other community living options. B. Collaborate with the Center for Disability Law on a project regarding a disparity between community living options for individuals with developmental disabilities compared to those with other physical disabilities. C. Participate in the steering committee to change Arizona State Law to include protections against employment discrimination of those with mental disabilities. D. Continue training consumers on advocacy techniques. E. Continue to collaborate and participate in the Governor's Council on Developmental Disabilities Legislative Consortium. F. Actively participate in the NCIL advocacy activities regarding Social Security reform. G. Continue to monitor new issues brought forth by consumers to recognize trends and take action as appropriate. (ii) Technical Assistance Plan A. Maintain a database and central technical file on assistive technology. Collaborate with the AZTAP and the new Community Information and Referral Project to ensure a wide range of available information. B. Continue to publish information in our monthly newsletter to alert consumers of new programs or projects that might be useful to them. C. Offer continuous educational opportunities to our peer mentor teams and consumers in advocacy and community resources. (iii) Plan to Collaborate with Other Agencies and Groups A. Expand outreach to organizations that do not necessarily practice or understand IL philosophy to educate them on the concept. Examples include extended care facilities, school systems, sheltered workshops, health care agencies and facilities. B. Continue to mobilize groups and work together on systems advocacy. Continue to stress the importance of global thinking that has long-term benefits for many consumers instead of meeting short-term goals of individual consumers. C. Expand our focus to include private-sector groups in our activities. For example, collaboration with private home builders to fund our home modification program instead of relying completely on HUD block grants. (iv) Affirmative Action Plans A. While in the past we have sent job openings to 87 organizations representing minority groups, this year's plan will include phone calls and visits to solicit possible candidates. B. We will expand upon our ethnic advisory groups beyond Native Americans. We will investigate the feasibility and need for advisory groups targeting other ethnic groups. (3) Outreach. Last year's plan included a rural/minority outreach staff position. This position established relationships with individuals from various ethnic and unserved or underserved areas of the state to increase their awareness of IL philosophy and ABIL programs. We provided training and technical assistance materials to the contacts in these communities. This year's plan will expand upon these efforts by providing more in-depth training. The focus, however, will remain on empowering people and supporting their efforts within their own community. The ultimate goal will be to establish cohesive IL networks statewide. Each time ABIL conducts outreach efforts, consumers and other participants are provided with an evaluation sheet to provide feedback on the value of the presentation and to identify additional and future needs. (4) ABIL continues to provide all four core services. Additionally we provide home modifications, socialization through recreation, young adult support groups, employment, and ADA services. ABIL's Executive Director is an active member of the Statewide Independent Living Council and participates to the maximum extent possible in the development of the SPIL. This has been problematic as the SILC is not yet consumer-controlled and most SILC members are not knowledgeable of the Rehab Act amendments even though training has been offered on several occasions. ABIL will continue to attempt to cooperate with the SILC. Currently, however, it is difficult and frustrating to do so with its current membership and structure. ABIL's work plan includes: 1. An annual board/consumer forum where consumers provide feedback to ABIL's board on current programs and recommendations for new programs to meet community needs. 2. Phone surveys conducted by interns to assess consumer satisfaction with services received. 3. Observation of service delivery methods by board members to provide feedback on potential service delivery improvements. 4. Active participation and collaboration in community activities to keep informed of what other organizations are doing so that information and referral can be timely and accurate. This is done through community meetings, hearings, job fairs, expos, etc. (5) ABIL continues to allocate significant resources to rural and minority outreach. Arizona has a vast rural area. ABIL serves 62% of the state population. Additionally, since we are located in the State capitol, we are expected to handle a significant amount of systems advocacy. This year's plan is detailed in (2) above. (6) Resource Development A. Establish an endowment fund. ABIL is establishing an endowment campaign to raise capital assets that will generate significant income for operating expenses. B. Expand the membership program to include an annual membership drive and offer membership incentives to consumers. C. Continue to negotiate with United Way to become a United Way Agency for early intervention peer mentoring. D. Evaluate the potential for funding our home modification program through private support from major home builders. Del Webb has been contacted to be our "champion". E. Expand and stabilize the EmployABIL program to generate excess program income to fund ABIL's IL operations. F. Evaluate a plan to provide employment mediation on a fee-for-service basis to employers. ABIL's long-term goal is to become completely self-sufficient without reliance on government funding of any kind by the year 2001. (7) Training ABIL will continue and refine as appropriate our training on self-advocacy, systems advocacy, IL philosophy, ADA and other related laws and peer support. ATTACHMENT II-C - CIL TRAINING AND TECHNICAL ASSISTANCE -- Consumer empowerment train-the-trainer training -- Dual disabilities and how systems interact (e.g., healthcare and mental health) -- Interaction between different laws (e.g. ADA vs. Fair Housing vs. Rehab Act vs. IDEA vs. Assistive Technology Act). -- Ongoing training on Social Security Work Incentives SAMPLE CIL WORK PLAN: HOUSTON CIL ATTACHMENT II - C(a): CIL WORK PLAN FOR NEXT FISCAL YEAR Service Delivery Goals Objective I: Continued organizational development for the provision of effective management of HCIL. Goals 1. Consumer-based/-directed self-help, self-advocacy, peer support organization providing equal access of services on a cross-disability basis in Houston Outcome Effective community-based service provider of independent living services to people with disabilities Responsibility Consumer-based Board of Directors (Board), Executive Director (Exec. Dir.), & consumers of HCIL services who have mobilized to form volunteer self-directed Support Work Teams in order to effect change in the lives of persons with disabilities in Houston Achieve By Ongoing Goals 2. Organizational Policy & Procedure (Philosophy) Manual for Board, Staff, Service Delivery Component and Financial Management System Outcome Written manual(s) revised and updated annually or as needed, with adherence thereof and independent financial audit Responsibility Exec. Dir., Board & Support Work Teams Achieve By Ongoing Goals 3. Effective organizational structure that ensures Center goals and objectives are met Outcome Written Quarterly and Annual Performance Reports Responsibility Exec. Dir. & Program Director (Prog. Dir.) Achieve By Ongoing Goals 4. Effective individual personnel assignments with outlined key tasks and critical success factors (program goals) with HCIL values of consumer control, self-help and self-advocacy in effect Outcome Achievement of goals as documented by monthly program/organizational reports of Staff Responsibility Exec. Dir., Prog. Dir., & annual staff performance evaluations Achieve By Ongoing Goals 5. Review and revise employee job tasks and responsibilities as needed Outcome Written job descriptions signed by employee Responsibility Exec. Dir. Achieve By Ongoing Goals 6. Maintain and update Consumer and Support Work Team Handbooks Outcome Handbooks reviewed and updated to reflect current input from Consumers and Work Team members, with distribution thereof Responsibility Exec. Dir., Prog. Dir., Consumers of HCIL services & Support Work Team members 12/31/95; Achieve By Ongoing Goals 7. Collaborate with Texas Rehabilitation Commission on state requirements for IL Centers in Texas Outcome Reporting requirements of Texas ILCs move toward national assurance and standards for all ILCs, producing 1) uniform, equal and consistent reporting requirements, and 2) a more productive and creative grantee/grantor relationship resulting in effective and diverse IL Service delivery for people with disabilities in Texas Responsibility Exec. Dir. through Director's Association for Texas ILCs (DATCIL) through trainings/ workshops Achieve By Ongoing; Quarterly Objective II: Provide peer counseling/support to consumers Goals 1. HCIL Consumers to receive direct peer counseling services Outcome At least 150 consumers will receive one hour of peer counseling during the year Responsibility Independent Living Specialists (IL Specialists) and Program Support Specialist (Prog. Supp. Specialist) Achieve By 09/30/96 Goals 2. Peer Associates will provide one-on-one counseling Outcome At least 20 consumers will be trained in peer counseling techniques. 5 or more will be assigned to work directly with new consumers. Responsibility Education Coordinator (Ed. Coord.); IL Specialists & Prog. Supp. Specialist to facilitate Achieve by 09/30/96 Goals 3. Peer Support Groups will meet on a scheduled basis Outcome At least 3 support/advocacy groups will meet bi-weekly Responsibility Ed. Coord., IL Specialists & Prog. Supp. Specialist Achieve By 09/30/96 Goals 4. Consumer Education and Support Work Teams will provide input to service delivery Outcome Work Teams will evaluate program quality on quarterly basis Responsibility Exec. Dir. & Prog. Dir. Achieve By 09/30/96 Objective III: Provide Independent Living skills training to consumers Goals 1. Training will be offered that addresses specific IL needs of unserved/ underserved population(s) Outcome Programs for persons of varied ethnic backgrounds and for persons who are deaf or hard of hearing will be offered on a continuing basis, including community-based trainings/work-shops on the ADA Responsibility Ed. Coord., Prog. Supp. Specialist & Consumer Education Support Team Achieve by 09/30/96 Goals 2. Identify, train instructors with disabilities to teach Independent Living (IL) Classes Outcome At least 10 persons with disabilities will be trained as IL instructors Responsibility Ed. Coord. Achieve By 09/30/96 Goals 3. IL Classes will be offered for group or individual instruction Outcome At least 50 consumers will participate in at least one of the classes offered. Leadership Development training will be provided once a quarter; a minimum of 10 consumers will receive this training Responsibility Ed. Coord., IL Specialists, & Prog. Supp. Specialist Achieve By 09/30/96 Goals 4. Independent Living Plans will be prepared for all who request them (or waiver signed) Outcome At least 150 new consumers will receive services Responsibility IL Specialists & Prog. Supp. Specialist Achieve by 09/30/96 Goals 5. Consumer Control will be promoted Outcome Quarterly Evaluation by Consumer Education & Support Work Team Responsibility Prog. Dir. Achieve By 09/30/96 Objective IV: Provide Information & Referral on various issues regarding disabilities Goals 1. Design & maintain database of disability related information Outcome Information will be updated on a continuous basis; at least weekly, BBS will be monitored/downloaded Responsibility I&R Specialists Achieve By 09/30/96 Goals 2. I&R provided to consumers and general public Outcome -- At least 4,000 calls will be answered during the year -- At least 50 organizations will receive information on disability issues Responsibility I&R Specialists Achieve By 09/30/96 Goals 3. Bi-monthly publication of HCIL newsletter Outcome Six editions of Spectrum to 3000+ mailing list Responsibility Exec. Dir. & all HCIL staff Achieve By Ongoing Goals 4. In-house resource library Outcome To add/update resource material on various disability related topics Responsibility I&R Specialists & Prog. Dir. Achieve By Ongoing Objective V: Provide individual & community advocacy to consumers Goals 1. Participate in activities to expand community options for people with disabilities Outcome Staff and consumers will attend at least 10 meetings affecting issues related to disabilities; participate on community boards or committees Responsibility Prog. Dir. Achieve By 09/30/96 Goals 2. Participate in activities to increase disability awareness Outcome Educate at least 50 consumers and 50 other people about rights of people with disabilities, with emphasis on self-help/self-advocacy Responsibility Ed. Coord. Achieve By 09/30/96 Goals 3. Offer consultation on accessibility Outcome Provide technical assistance to 25 businesses or entities on ADA requirements Responsibility IL Specialists, Prog. Supp. Specialist, & Support Work Team Achieve By 09/30/96 Goals 4. Conduct disability awareness training Outcome Offer training to 25 civic groups/25 businesses/10 governmental entities Responsibility Ed. Coord. Achieve By 09/30/96 goals 5. Political awareness promoted Outcome At least 2 public forums with candidates/office holders Responsibility IL Specialists, Prog. Supp. Specialist & Legislative Affairs Support Team Achieve By 09/30/96 Objective VI: Provide community education services through outreach Goals 1. Outreach to unserved/ underserved will be conducted Outcome At least one outreach activity will be scheduled per month to access populations that are unserved/ underserved with a 20% increase Responsibility Ed. Coord. & Consumer Education Support Team Achieve By 09/30/96 Goals 2. Outreach to people with disabilities who are making transition from school to postsecondary life will be conducted Outcome At least one presentation per month will be made at a school or training facility on IL and HCIL services Responsibility Ed. Coord. Achieve By 09/30/96 goals 3. Cooperative efforts with other disability organizations will be fostered and developed Outcome Other disability organizations will be solicited to establish common ground; at least 2 projects will be worked on jointly Responsibility Exec. Dir., Prog. Dir. & Networking Support Team Achieve by 09/30/96 Outcome At least 2 organizations per month will be invited to agency orientation Responsibility Prog. Dir. Achieve by 09/30/96 Goals 4. Media awareness expanded Outcome At least one news release per month to be sent on CIL services Responsibility Marketing Support Team Achieve By 09/30/96 Goals 5. Expand services to outlying areas Outcome Conduct feasibility study to determine efficacy of satellite office Responsibility Board, Exec. Dir. & Prog. Dir. Achieve by 09/30/96 Objective VII: Provide resource development for continued growth and stability. Goals 1. Diversify funding sources Outcome At least 3 RFPs will be submitted for unrestricted funds; at least 3 RFPs for program or service specific funds will be submitted; mail list for solicitation will be developed (at least one mailing made) -- 10% increase in non-federal funds Responsibility Exec. Dir., Board & Funding Support Team Achieve By 09/30/96 Goals 2. Continued revision and monitoring of long-range fundraising plan for HCIL Outcome To assure long-range fundraising plan is still feasible and productive Responsibility Board & Exec. Dir. Achieve By 01/31/96 Goals 3. Continued solicitation of volunteers in service to the goals and objectives of HCIL Outcome 7,244 in-kind volunteer hours in support of HCIL and its programs Responsibility Exec. Dir. & Prog. Dir. Achieve by 09/30/96 Objective VIII: Provision for training for Staff, Board, and Volunteer Support Work Teams. Goals 1. Continued orga-nizational development training for Exec. Dir. Outcome At least 2 trainings per year Responsibility Board & Exec. Dir. Achieve by 09/30/96 Goals 2. Training for Board, Staff and Support Work Teams on continuous basis Outcome At least one training per quarter on IL philosophy and issues Responsibility Exec. Dir. Achieve by 09/30/96 Goals 3. Training for Board Outcome 2 trainings per year on policy development, governance, etc. Responsibility Executive Committee of Board of Directors & Exec. Dir. Achieve by 09/30/96 Goals 4. Staff and Support Work Teams training Outcome At least 2 trainings per year on service provision Responsibility Prog. Dir. Achieve by 09/30/96 Goals 5. Consumer education Outcome At least 2 trainings or workshops on advocacy per quarter Responsibility Ed. Coord. & Consumer Education Support Team Achieve by 09/30/96 Objective IX: Evaluation of the effectiveness in meeting the program goals. Goals 1. Use consumer assessments to measure impact and quality of service delivery by using a "Before and After Services Received" survey tool Outcome Receipt of evaluation feedback from consumers regarding their level of independence before and after receiving services from HCIL Responsibility Exec. Dir. & Prog. Dir. Achieve by Ongoing Goals 2. Conduct annual public forum/focus group to provide consumer and community input/evaluation Outcome Additional feedback to evaluate Center services and direction thereof Responsibility Board, Exec. Dir. & Staff Achieve by 09/30/96 Goals 3. Annual written consumer evaluation placed in Center newsletter for anonymous reporting of consumer satisfaction or dissatisfaction of services Outcome Identify needs for additional services or different services for HCIL Responsibility Board, Exec. Dir. & Prog. Dir. Achieve by 09/30/96 Goals 4. Consumer Education and Support Work Teams will provide input to service delivery Outcome Work Teams will evaluate program quality on quarterly basis Responsibility Exec. Dir. & Prog. Dir. Achieve by 09/30/96 TELECONFERENCE EVALUATION COMPLETING THE 704 REPORT: SILCS & CENTERS December 12, 1995 1. Describe your basic understanding of these topics BEFORE and AFTER this teleconference by circling the appropriate numbers below (7 being "high, detailed knowledge" and 1 being "none"). BEFORE AFTER none high none high Overview of the Development Process -- Overview of the 704 report 1 2 3 4 5 6 7 1 2 3 4 5 6 7 -- Purpose and background of the 704 report 1 2 3 4 5 6 7 1 2 3 4 5 6 7 -- Reporting obligations of the SILC 1 2 3 4 5 6 7 1 2 3 4 5 6 7 -- Reporting obligations of centers 1 2 3 4 5 6 7 1 2 3 4 5 6 7 -- Findings from the 1994 reports 1 2 3 4 5 6 7 1 2 3 4 5 6 7 2. What parts of the teleconference did you find MOST HELPFUL? Why? 3. What parts of the teleconference would you change? Why? 4. Did this teleconference meet your expectations? If not, what were your expectations? How could the trainers better meet them? 5. This teleconference was: _____ too long _____ too short _____ about right in length Comments: 6. Do you think the level of content in this workshop was appropriate? If not, what level would have been better for you? 7. How could the materials be improved? 8. If there was another independent living-related teleconference, what topics would you want covered? 9. Was this teleconference accessible to you as a participant (i.e., equipment, materials, presentation)? What suggestions do you have for improving accessibility? 10. Please make any other comments about this teleconference below. 11. How would you rate the OVERALL QUALITY of this teleconference? (circle number) 1........................................2........................................3...................... ................4 Poor Fair Good Excellent 12. Rate the following elements of the teleconference from 7 ("excellent") to 1 ("very poor"). Very Poor Excellent Sound/Clarity 1 2 3 4 5 6 7 Rented equipment (if used) 1 2 3 4 5 6 7 Please make any other comments related to this teleconference. Name and Telephone (OPTIONAL) PLEASE RETURN TO: Dawn Kemp-Moye NCIL 2111 Wilson Blve., Suite 405 Arlington, VA 22201 703-525-3406 (V) 703-525-3407 (TTY) 703-525-3409 (Fax) INDEPENDENT LIVING NETWORK _______________________________________________ NCIL/ILRU NATIONAL TRAINING & TECHNICAL ASSISTANCE PROJECT TELECONFERENCE AUDIO TAPE ORDER FORM An audio cassette of the teleconference entitled: Completing the 704 Report: SILCS & Centers is available. If you would like a copy, please fill out the order form below. NAME: CENTER: ADDRESS: TELEPHONE: Fax: Number of sets: x $15.00 = $ (shipping included) Please mail order form and payment to: National Council on Independent Living 2111 Wilson Blvd., Suite 405 Arlington, Virginia 22201 703-525-3406 (V) 703-525-3407 (TTY) 703-525-3409 (Fax) UNITED STATES DEPARTMENT OF EDUCATION OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES REHABILITATION SERVICES ADMINISTRATION WASHINGTON, DC 20202-2741 POLICY DIRECTIVE RSA-PD-95-07 RSM-0501 DATE: 8/29/95 ADDRESSEES: STATE VOCATIONAL REHABILITATION AGENCIES (GENERAL) STATE VOCATIONAL REHABILITATION AGENCIES (BLIND) STATEWIDE INDEPENDENT LIVING COUNCILS CENTERS FOR INDEPENDENT LIVING CLIENT ASSISTANCE PROGRAMS RSA SENIOR MANAGEMENT TEAM SUBJECT: Section 704 Annual Performance Report POLICY STATEMENT: This transmits the Section ()704 Annual Performance Report consisting of two parts and instructions for the completion and submittal of the Reports for the State Independent Living Services (SILS), and Centers for Independent Living (CIL) programs. OMB approval number for this plan is 1820-0606. The purpose of this report is to: -- Serve as a performance measuring instrument of independent living (IL) programs, both quantitatively and qualitatively; -- Determine the training and technical Assistance needs of Statewide Independent Living Councils (SILCs) and Centers for Independent Living (CILs) as required by section 721(b)(3) of the Act; -- Determine CIL compliance with the standards, assurances, and indicators of compliance with the standards in section 725 of the Act and 34 CFR Part 366; -- Collect information necessary for issuance of continuation awards for qualified CILs funded under the CIL program; -- Collect the data required by sections 13, 706, 721, and 725 of the Rehabilitation Act of 1973, as amended (Act) for the State Independent Living Services (SILS) program and the Centers for Independent Living (CIL) programs; -- Serve as the basis for on-site reviews of the Chapter 1, Title VII of the Act program grantees; and -- Obtain a report from Statewide Independent Living Councils and Designated State Units regarding their activities in the State plan for independent living development, administration, monitoring, and evaluation, including an assessment of consumer satisfaction with the IL programs in the States. CITATIONS IN LAW: Title VII of the Rehabilitation Act of 1973, as amended, Sections 13, 704(m)(4)(D), 705(c)(5), 706(d), 722, 723, 725(c)(8), and 725(c)(13) CITATIONS IN REGULATIONS: 34 CFR Parts 364, 365, and 366 EFFECTIVE DATE: Upon Issuance EXPIRATION DATE: August 31, 1998 INQUIRIES: RSA Regional Commissioners Fred Schroeder (signed) Commissioner Rehabilitation Services Administration SECTION 704 ANNUAL PERFORMANCE REPORT INDEPENDENT LIVING PROGRAMS Chapter 1, Title VII PART I 7/18/95 Rehabilitation Act of 1973, as amended TABLE OF CONTENTS GENERAL INSTRUCTIONS Purpose I Glossary of Terms iii Content of 704 Annual Performance Report vi Who must Complete the Report and Where must it be Submitted? vii When must the Report be Submitted to RSA? viii Transmitting the Report Electronically viii Record Retention ix Guidance for completing Part I of the Report ix Sources and Amounts of Resources ix Staffing (FTE) x Numbers and Types of Individuals Receiving Services x Types of Services Provided and Numbers of Individuals Receiving Services Definitions of Services xiii Attachments xvi Attachment I - A - Grants and Contracts Attachment I - D(a) - SILC activities Attachment I - D(b) - Training and Technical Assistance Needs Attachment I - E - DSU Activities Attachment I - F - Narrative Regional and Central Office Directory xviii Part I SUBPART IA - ADMINISTRATIVE DATA I - Resources I-1 II - Allocation of Funds Part B, Ch. 1 Funds I-2 III - Direct Service Activity by DSUs I-3 IV - Grants, Contracts or other Arrangements for Use of Part B Funds I-3 V - Staffing I-4 SUBPART IB: NUMBERS AND TYPES OF INDIVIDUALS WITH SIGNIFICANT DISABILITIES RECEIVING SERVICES EITHER DIRECTLY FROM THE DSU OR THROUGH GRANTS OR CONTRACTS I - Consumers Served during Year I-5 II - CSRs Inactive @ Sept. 30 I-5 III- CSRs Active @ Sept. 30 I-5 IV - Time CSR active I-5 V - Consumer Achievements I-5 VI - Age I-6 VII - Gender I-6 VIII - Race/ethnicity I-6 IX - Disability I-7 X - Living Arrangements CSR @ Sept. 30 I-7 XI - Source of Personal Assistance Services Reimbursement CSR @ Sept. 30 I-7 SUBPART IC: TYPES OF STATE INDEPENDENT LIVING SERVICES PROVIDED EITHER DIRECTLY OR THROUGH GRANTS, CONTRACTS, OR OTHER ARRANGEMENT I - Community services I-8 II - Individual services # of Individuals I-8 SUBPART ID: STATEWIDE INDEPENDENT LIVING COUNCIL (SILC) REPORT I - General Activities I-9 II - Design for Network of Centers I-9 III - Evaluation by SILC I-9 IV - Composition of the SILC I-11 V - Placement of the SILC I-11 SUBPART IE: DSU ACTIVITIES I - DSU Activities I-12 II - DSU Monitoring I-12 SUBPART IF: NARRATIVE - COMPARISON WITH PRIOR YEARS I-13 OMB NUMBER: 1820-0606 EXPIRATION DATE: 8/31/97 UNITED STATES DEPARTMENT OF EDUCATION OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES REHABILITATION SERVICES ADMINISTRATION WASHINGTON, D.C. 20202-2741 INSTRUCTIONS FOR COMPLETION AND SUBMITTAL OF THE SECTION 704 PART I ANNUAL PERFORMANCE REPORT (Part I) PURPOSE OF THE 704 REPORT The purpose of this report is to: (a) Serve as a performance measuring instrument of independent living (IL) programs, both quantitatively and qualitatively; (b) Determine the training and technical Assistance needs of Statewide Independent Living Councils (SILCs) and Centers for Independent Living (CILs) as required by section 721(b)(3) of the Act; (c) Determine CIL compliance with the standards, assurances, and indicators of compliance with the standards in section 725 of the Act and 34 CFR Part 366; (d) Collect information necessary for issuance of continuation awards for qualified CILs funded under the CIL program; (e) Collect the data required by sections 13, 706, 721, and 725 of the Rehabilitation Act of 1973, as amended (Act) for the State Independent Living Services (SILS) program and the Centers for Independent Living (CIL) program; (f) Serve as the basis for on-site reviews of the Chapter 1, Title VII of the Act program grantees; and (g) Obtain a report on SILC and DSU activities. The report is structured to: (a) Establish a uniform, performance based, program specific, reporting system to compile an accurate national report on independent living; and (b) Enable each State to have information on all funds expended for IL in the State, for what the funds paid, who was served, with what services, and for RSA to be able to compare State and CIL performance with other States and other CILs. (Authority: 13, 704(m)(4)(D), 705(c)(5), 706(d), 722, 723, 725(c)(8), 725(c)(13) of the Act; 34 CFR Parts 364, 365, 366) Each State receiving funds under part B or part C of Chapter 1 of Title VII of the Act must complete the Part I report. A list of RSA regional and central office contacts, addresses, telephone numbers, and electronic contact user IDs, is included at the end of these instructions. GLOSSARY OF TERMS Act The Rehabilitation Act of 1973, as amended CIL A "Center for Independent Living" meeting the definition in 702 of the Act, and the standards in 725 of the Act. CIL program The "Centers for Independent Living program" funded under part C, Chapter 1 (Ch. 1) of Title VII of the Act (part C). Consumer Any individual with a significant disability who is eligible for IL services under 34 CFR 364.40(a) and is currently receiving or has been provided with any IL services under the program other than information and referral. Core Services IL services defined in 7(29) of the Act--information and referral, IL skills training, peer counseling (including cross-disability peer counseling), and individual and systems advocacy. CSR A "Consumer Service Record" maintained for an eligible consumer receiving IL services and meeting the requirements of 34 CFR 364.53. Where IL services are provided to the parent or guardian of a consumer, the CSR is established for the consumer and the services provided are reflected in that CSR. DSU The "Designated State Unit, or Units" identified under 101(a)(1) of the Act, to jointly with the Statewide Independent Living Council, develop and sign the State plan for Ch. 1 of Title VII under 704 of the Act. The term includes a State agency solely designated under State law to provide IL services to individuals who are blind. In such State, the State agency for the Blind may administer the provisions in the attachments to the State plan providing for services to individuals who are blind. In a "723 State", the DSU administering the CIL program is always the general agency. Earmarked Funds appropriated by the State and expressly or clearly identified as State Funds expenditures in the relevant fiscal year for the sole purpose of funding the general operation of CILs meeting the requirements of 702 and 725 of the Act. It does not include Federal funds, State purchase of service funds, State attendant care funds, or Social Security Administration reimbursement funds. 722 State A State where RSA issues grants under part C directly to eligible agencies (CILs). 723 State A State where the DSU issues grants or assistance contracts under part C to eligible entities for the planning, establishment, and operation of CILs. IL "Independent Living" ILP An "Independent Living Plan" for the provision of IL services mutually agreed upon by an appropriate staff member of a service provider and an individual with significant disabilities. Minority Means Alaskan Natives, American Indians, Asian Americans, Blacks (African Groups Americans), Hispanic Americans, Native Hawaiians, and Pacific Islanders. Reporting The most recent Federal fiscal project year completed - October 1 to September 30. Year RSA The "Rehabilitation Services Administration" in the Department of Education, Office of Special Education and Rehabilitative Services. Service Provider-- (I) A DSU which directly provides IL services to consumers; or (ii) A CIL; or (iii) An entity which: (A) provides IL services under a grant or contract; and (B) is delegated responsibility for the determination of eligibility for IL services. SILC The "Statewide Independent Living Council" established in each State as required by 704 and 705 of the Act. SILS The "State Independent Living Services program" funded under part B, Ch. 1 of Title VII of the Act. SPIL The "State Plan for Independent Living," which governs the State IL Services and Centers for Independent Living programs and describes the services to be provided under the IL Services for Older Individuals who are Blind program. STATE Wherever the term "State" is used, it refers to the State in its sovereign sense. For purposes of Title VII, the DSU(s) and the SILC jointly represent the State, except where otherwise noted. CONTENT OF THE REPORT The annual 704 report consists of two parts. Part I contains the reports of the SILC's and DSU's activities for the reporting year. It also contains data from consumer service records where those records are maintained outside of a CIL reporting in Part II. Part II contains a CIL's self-evaluation of compliance with the requirements of Section 725 of the Act, a comparison of the CIL's activities during the reporting year with its work plan for that year, and data from consumer service records maintained by the CIL. It also contains the CIL's work plan and any necessary budget amendments for the next fiscal year. Part I contains: (a) Subpart IA - Administrative Data: Subpart IAI provides information on resources, including part B, Chapter 1 of Title VII of the Act (part B), other Federal funds, State, and other funds, received by the DSU during the reporting year; (b) Subpart IAII - Allocation of part B funds: This subpart provides information on the amounts of part B funds obligated during the reporting year for the allowable purposes defined in the State plan for independent living (SPIL) approved for the reporting year; (c) Subpart III - Provision of Services: Requires that the State provide the information in Subparts IB and IC for IL service providers other than CILs reporting in Part II; (d) Subpart IB - Demographics on Individuals with Significant Disabilities Receiving Services: Provides information from CSRs controlled by the State (i.e., not maintained in a CIL required to report in Part II) on the numbers and types of individuals with significant disabilities receiving IL services either directly from the DSU or through grants, contracts, or other agreements with the State; (e) Subpart IC - Types and Amounts of Services Provided: A report of community (Subpart ICI) and individual (Subpart ICII) IL services provided either directly by the DSU or through State grants or contracts. Information on individual services is reported only from CSRs controlled by the State (i.e., not maintained in a CIL required to report in Part II); (f) Subpart ID - Report of the SILC's activities (includes the SILC survey of its technical assistance and training needs for the next fiscal year; (g) Subpart IE - DSU Activities: A report on activities of the DSU(s); and (h) Subpart IF - Narrative and Comparison with Prior Year Activities: This subpart provides additional information, jointly developed by both the DSU and the SILC, of significant activities not reported in other subparts, program accomplishments, goal achievements, difficulties encountered, and comparison with prior years. WHO MUST COMPLETE PART I? (a) Each DSU and SILC will jointly complete Part I. In a State with a separate agency serving individuals who are blind, the production of 704 Part I must be coordinated among the DSUs and the SILC. Only a single Part I report, with data aggregated from the State's reporting entities will be accepted by RSA. (c) Subparts IB and ICII. These subparts report information from CSRs. The DSU reports in Part I only information in CSRs maintained by a service provider other than a CIL reporting in Part II. WHO MUST COMPLETE THE REPORT AND WHERE MUST IT BE SUBMITTED? (a) Section 722 State. (1) The DSU(s) and the SILC will jointly submit Part I to RSA (RSA regional and central office). (2) CILs funded solely with part B or State funds submit their Part II reports to the DSU and the SILC. The DSU will transmit the CIL reports to RSA with the Part I report. (b) Section 723 State. CILs will file their Part II reports with the DSU and the SILC. The State will aggregate the data and summarize other information in the Part II reports with the Part I report and attach the incoming reports from the CILs for reference, including the State's Technical Assistance and Training Needs Survey. The aggregate Part I report will be forwarded to RSA (one copy to the regional office, one copy to RSA central office). WHEN MUST THE REPORT BE SUBMITTED TO RSA? (a) 704 Part I. Part I is due to RSA 90 days after the end of the reporting year (December 29). (b) 723 States. The Part I and Part II reports are due to RSA 90 days after the end of the reporting year (December 29) . TRANSMITTING THE REPORT ELECTRONICALLY RSA will transmit to all States and CILs computer software to enable States and CILs to file the 704 Reports by computer on the RSA Bulletin Board (RSA BBS). Please send original signature pages to the appropriate RSA regional office. To file: RESERVED INSTRUCTIONS FOR ELECTRONIC FILING UNDER THE ELECTRONIC REPORTING SYSTEM UNDER DEVELOPMENT WILL BE TRANSMITTED TO YOU ALONG WITH THE REPORTING SOFTWARE. RECORD RETENTION The information provided in this report by Federal grantees is subject to confirmation at an on-site compliance review; therefore, financial records, statistical records, and all supporting documents and other records pertinent to the grant award, adequate to document the accuracy of the information and statements in the 704 Annual Performance Report, must be kept for five years. (Authority:  706(c), 723(g) of the Act; 34 CFR 74.53) INSTRUCTIONS FOR COMPLETING THE 704 ANNUAL PERFORMANCE REPORT SOURCES AND AMOUNTS OF RESOURCES (Part I, Subpart IA) (a) Section IAI - report the amounts of resources received by the State or CIL from each of the sources indicated during the reporting year. (b) Section IAII - report on the amounts of funds obligated by the State during the reporting year; thus the amounts reported in Section IAII may differ from the amounts reported in Section IAI. (c) Section IAIV - Grants, Contracts, or other Arrangements for part B funds. (1) Name of grantee or contractor. All that is needed is an identifier sufficient to identify the contract or grant in the event of an on-site review or audit. (2) Use for funds. Enter the identifier from Section IAII., e.g., II(d) would signify a grant to a CIL for the general operation of the CIL. (d) Section IAV - Staffing (1) "FTE" means one person working full-time for one year (Approximately 2080 hours). Part-time employees and employees who worked for any fraction of the year are counted as a fraction of an FTE to the nearest tenth. To compute FTE, determine the number of hours (excluding any overtime) for which employees were actually paid during the last six months of the reporting year. Multiply the hours worked x 2, ö by 2080 = FTE. (2) Categories of positions are: (I) Decisionmaking - e.g., executive director, supervisors, and any other policy position; (ii) Staff - e.g., counselors, teachers, trainers, and other staff. NUMBERS AND TYPES OF INDIVIDUALS WITH SIGNIFICANT DISABILITIES RECEIVING SERVICES (Subpart IB) I - Active Consumer Service Records--This is a count of individuals who were determined eligible for any part of the reporting year, and for whom a CSR was initiated. (a) Enter the number of active CSRs carried over from September 30 of the preceding year. (b) Enter the number of new CSRs initiated during the year. (c) Enter the total number of consumers served during the year. II Inactive Consumers at Year End--Record consumer records that have been purged from the active CSR file because the individual has moved, stated that he or she had no further interest in the program, died, achieved all goals set, or for other reasons. III Active Consumers and Year End--Indicate the total number of Consumers remaining active on September 30 of the reporting year (I(c) - II(f)). For the remaining sections of this subpart, RSA intends that the demographic information include all consumers served during the year. IV Time Consumers active--Enter the numbers of CSRs and the time since initiation. V Consumer Achievements--Report the total numbers of goals set by consumers during the reporting year and the number of goals achieved by consumers during the reporting year. Consumers may set and/or achieve more than one goal, and a goal may be set in one year and achieved in another. Please classify goals in the following categories: (a) Self-care - Goals to improve/maintain an individual's autonomy with respect to activities of daily living such as personal grooming and cleaning, toileting, meal preparation, shopping, eating, etc. (b) Communication - Goals involving either improvement in the consumer's ability to understand and acknowledge communication by others (receptive), or improvement in one's ability to produce verbal language, sign language and other communication (expressive). (c) Mobility - Goals to improve an individual's access to his life space, environment or community. This increase in access may occur by improving the person's own ability to move or transport himself or herself, or by allowing the consumer to be moved or transported by another person. (d) Residential - Goals that provide for change in living situations with increased autonomy for the individual with significant disabilities. (e) Educational - IL goals of an academic or training nature that are expected to improve the consumer's basic knowledge or increase his or her ability to perform certain skills. (f) Vocational - IL goals related to obtaining, maintaining, or advancing in employment. (g) Other - Other IL goals not included in the above categories. VI Age--Enter number of consumers in each age category at the end of reporting year. For CSRs put in inactive status during the year, use consumers' ages to be reached during the reporting year. VII Gender--Enter number of males and females served during the fiscal year. VIII Race/ethnicity--Enter a count of individuals by race or ethnicity. Information should be solicited on a voluntary basis. If unavailable, a consumer should be included in the group to which he or she appears to belong. If you don't know, leave it blank. For persons who are of mixed racial origin, use the category which reflects the individual's choice. The racial categories are: (a) White (non-Hispanic)--A person having origins in any of the original peoples of Europe, North Africa, or the Middle East. (b) Black (non-Hispanic)--A person having origins in any of the black racial groups of Africa. (c) American Indian or Alaskan Native (including Native Hawaiians)--A person having origins in any of the original peoples of North America or Hawaii, and who maintains cultural identification through tribal affiliation or community identification. (d) Asian or Pacific Islander - A person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands. This area includes, for example, China, India, Japan, Korea, the Philippine Islands, and Samoa. (e) Hispanic - A person of Mexican, Puerto Rican, Cuban, Central or South American, or similar origin. IX Disability--Enter a count of individuals with a significant cognitive, mental, physical, sensory, or multiple disability, whose ability to function independently in the family or community or whose ability to obtain, maintain, or advance in employment is substantially limited. X Living arrangements--Indicate the living arrangements of individuals at the end of the reporting year or when a consumer moved to inactive status. (a) Institution--individuals living in nursing homes, etc; Note that residing in an institution does not render an individual ineligible for IL services so long as the individual has the ability to function, continue to function, or move towards functioning independently in the family or community (which could include the nursing home). (b) Dependent: w/family or friends--individuals living with and dependent on family or friends; (c) Assisted Living--includes halfway house, group home, etc; (d) Independent--number of individuals who are independent, whether living alone or with family or friends; or (d) Other. XI Source of Personal Assistance Services Reimbursement--As this is a new service authorized in the 1992 Amendments and is a major IL service, data regarding the sources of funding for the service is needed for State and Federal planning and budget purposes. Please indicate the number of persons receiving PAS from the sources indicated. Where funds are administered by the service provider and "passed through" to the consumer, please report the amounts of these funds in the financial section of the report. TYPES OF SERVICES PROVIDED AND NUMBERS OF INDIVIDUALS RECEIVING SERVICES (Subpart IC) I - Community services--States must indicate by responding "Y" for Yes and "N" for No next to the community services provided by the State. States are encouraged but not required to report the number of hours of community service provided. If the State maintains records sufficient to report the number of hours and chooses to report the number of hours, in the appropriate columns, record the total person hours of staff time expended on particular community service activities, e.g., hours spent working on an advertising campaign to raise community awareness of ADA. Please round to the nearest whole hour. (a) Information and referral (I&R), as a community service entails the provision of I&R to groups of individuals and does not necessitate initiating a CSR, e.g., speaking at the Rotary Club luncheon about ADA. The chief difference between this service and the I&R under individual services listed later is this service is provided to groups rather than one individual at a time. (b) Community and systems advocacy--efforts to implement local policy and legislation to make facilities, services and opportunities available/accessible to individuals with disabilities. (c) Outreach--efforts to locate and serve individuals with significant disabilities in the community. (d) Publications--accessibility guides, disability awareness brochures, ADA, how to advice, etc. (e) Community education--activities and information programs to enhance the community's awareness of disabilities and disability issues, e.g., local TV, radio, or newspaper campaigns. (f) Maintaining registries--includes activities related to creating and maintaining directories for personal assistants, recreation opportunities, accessible transportation, accessible housing, and other support services. (g) Other--Activities that do not fit in any of the above. II - Individual Services--List the number of consumers receiving each of the services offered during the reporting year. The numbers of individuals utilizing a service affords a measure of the benefits derived from that particular service made available by a service provider; it is not expected to equal the number of consumers, as a single individual may receive a number of different services. IL services include, but are not limited to the following: (a) Advocacy/legal services - advocacy and legal assistance and/or representation in obtaining access to those benefits, services and programs to which an individual with significant disabilities may be entitled. (b) Assistive devices/equipment - provision of specialized devices and equipment such as TDD's, wheelchairs and lifts, or provision of assistance to obtain these devices and equipment from other sources. (c) Childrens services - IL services provided to a child under age six. (d) Communication services - services directed to enable individuals with significant disabilities to better communicate such as: interpreter services, including tactile interpreter services for deaf-blind individuals; training in communication equipment use; Braille training; and reading services. (e) Counseling services, including psychological, psychotherapeutic, and related services. (f) Family services - services provided to the family members of an individual with significant disabilities when necessary for improving the individual's ability to live and function more independently, or his or her ability to engage or continue in employment. Such services may include respite care. (Record the service in the consumer's CSR on behalf of whom services were provided to the family.) (g) Housing or shelter services, including services related to securing housing or shelter, adaptive housing services (including appropriate accommodations to and modifications of any space used to serve, or occupied by, individuals with significant disabilities). A CIL shall not provide housing or shelter as an IL service on either a temporary or long-term basis unless the housing or shelter is incidental to the overall operation of the CIL and is provided to any one individual for a period not to exceed eight weeks during any six-month period. (h) Independent Living Skills Training and Life Skills Services and Training - IL skills training is instruction to develop independent living skills in areas such as personal care, coping skills, financial management, social skills, and household management, including education and training necessary for living in the community and participating in community activities. Life skills training and services are independent living skills training and interpreter, and reader services for individuals with cognitive and sensory disabilities. (I) Information and referral services - individual I&R provided to a consumer and recorded in his or her CSR. (It is not necessary to record I&R in a CSR nor establish a CSR for an individual receiving only I&R services). The greater number of individuals receiving I&R services are when individuals receive single face-to-face contact or one or two telephone calls that may result in providing information verbally, disseminating printed material and/or referral to another source for services or further information. It may include a minor one-time service of such a nature that establishment of a CSR is not justified. Some service providers record I&R as strokes on an answering pad--others as phone minutes; some CILs create a CSR or other files for future contact and outreach. (j) Mental Restoration - psychiatric restoration services including maintenance on psychotropic medication, psychological services, and treatment management for substance abuse. (k) Mobility training - variety of services involved in assisting individuals with cognitive and sensory impairments to get around their homes and communities. (l) Peer Counseling - counseling, teaching, information giving, and similar kinds of contact provided by other individuals with disabilities. (m) Personal assistance services, including attendant care and the training of personnel providing such services. (n) Physical restoration - restoration services including medical services; therapeutic treatments, such as physical therapy, occupational therapy, speech, language and hearing therapy; health maintenance; eyeglasses and visual services; and prosthetic, orthotic and other assistive appliances and devices. (o) Preventative services - services intended to prevent additional disabilities, or to prevent an increase in the severity of an existing disability. (p) Prostheses and other appliances (See also Rehab technology) (q) Recreational services - provision or identification of opportunities for the involvement of individuals with significant disabilities in meaningful leisure-time activities; participation in community affairs and/or other recreation activities that may be competitive, active or quiet. (r) Rehabilitation technology - provision of, or assistance to obtain through other sources, adaptive modifications which address the barriers confronted by individuals with significant disabilities with respect to education, rehabilitation, employment, transportation, independent living and/or recreation. (s) Therapeutic treatment - services provided by registered occupational, physical, recreational, or speech therapists. (t) Transportation - provision of, or arrangements for provision of transportation. (u) Youth Services - services provided to youth with significant disabilities (ages 6 - 17); training to develop skills specifically designed for youths to promote self-awareness and esteem, develop advocacy and personal power skills, and explore career options. (v) Vocational services - any of the services defined in 103 of the Act. (w) Other - any IL service not listed above. ATTACHMENTS In preparing the various attachments, please insure that the State's name and report year appear at the top of each page. Attachment I - A - Grants and contracts In grants or contracts for the provision of IL services, the attachment identifies where eligibility is determined and where the CSR is maintained; for other grants or contracts, the attachment describes the objectives, activities, and results achieved. Address exemplary or innovative practices that are considered useful or worthy of replication in Subpart IF. ATTACHMENT I - D(a) - SILC activities This attachment contains a summary of activities of the SILC, a report on solutions to problems encountered; a report on the development and implementation of the design for the CIL network; and a report on evaluation and monitoring activities conducted by or participated in by the SILC. Address exemplary activities or major problems encountered in Subpart IF. ATTACHMENT I - D(b) - Training and technical assistance needs This attachment describes the SILC's training and technical assistance (TA) needs for the next fiscal year. It may also contain TA and training needs for CILs in the State, identified by the SILC in its evaluation and monitoring activities. Please be specific rather than general and, where appropriate, put needs in priority order. ATTACHMENT I - E - DSU activities This attachment contains a summary of DSU activities, results of DSU evaluations, joint evaluation activities with the SILC, monitoring activities, and, in 723 States, the results of periodic and on-site reviews of CILs in the State. ATTACHMENT I - F - DSU and SILC Narrative This attachment contains a narrative with additional information, significant activities, exemplary practices, program accomplishments, goal achievements, difficulties experienced and how they were resolved, and how these compare with the immediately preceding year. Please do not report information in this subpart that is included in another attachment. RSA REGIONAL OFFICE DIRECTORY REGION I REGION III Mr. John J. Szufnarowski Dr. Ralph N. Pacinelli RSA Regional Commissioner RSA Regional Commissioner 01-0041 03-2050 Dept. of Education, OSERS Dept. of Education, OSERS J.W. McCormack Post Office 3535 Market St., Rm 16120 and Court House, Rm. 232 Philadelphia, PA 19104 Boston, MA 02109 9-1-215-596-0317 9-1-617-223-4085 Fax: 9-1-215-596-0471 Fax: 9-1-617-223-4573 TDD: 9-1-215-596-0269 TDD: 9-1-617-223-4097 RSA BBS USER-ID: RSARCIII RSA BBS USER-ID: RSARCI -- District of Columbia -- Connecticut -- Delaware -- Maine -- Maryland -- New Hampshire -- Virginia -- Rhode Island -- West Virginia -- Vermont -- Pennsylvania -- Massachusetts Hours: 8:00 - 4:30 Hours: 8:30 - 5:00 EDST: 8:00 - 4:30 EDST: 8:30 - 5:00 REGION II REGION IV RSA Regional Commissioner RSA Regional Commissioner 02-1050 04-3050 Dept. of Education, OSERS Dept. of Education, OSERS 26 Federal Plaza, Room 1239 101 Marietta St., N.W., New York, New York 10278 Suite 2210, P.O. Box 1691 9-1-212-264-4016 Atlanta, GA 30301 Fax: 9-1-212-264-3029 9-1-404-331-2352 TDD: 9-1-212-264-4028 Fax: 9-1-404-331-0494 RSA BBS USER-ID: RSARCII TDD: 9-1-404-730-3825 -- New Jersey RSA BBS USER-ID: RSARCIV -- Puerto Rico -- Alabama -- Virgin Island -- Florida -- New York -- Kentucky -- N. Carolina -- S. Carolina Hours: 8:00 - 4:30 -- Tennessee EDST: 8:00 - 4:30 -- Georgia -- Mississippi Hours: 8:00 - 5:00 EDST: 8:00 - 5:00 REGION V REGION VII Mr. Terry Conour RSA Regional Commissioner RSA Regional Commissioner 07-6050 05-4050 Dept. of Education, OSERS Dept. of Education, OSERS 10220 N. Executive Hills 401 South State St., Suite 700E Blvd. Chicago, IL 60605-1202 Kansas City, MO 64153- 1367 9-1-312-886-5372 Fax: 9-1-312-353-7341 9-1-816-891-8015 TDD: 9-1-312-353-9694 Fax: 9-1-816-374-6627 RSA BBS USER-ID: RSARCV TDD: 9-1-816-374-6917 -- Indiana RSA BBS USER-ID: RSARCVII -- Michigan -- Iowa -- Minnesota -- Kansas -- Ohio -- Nebraska -- Wisconsin -- Missouri -- Illinois Hours: 8:00 - 4:30 Hours: 8:15 - 4:45 EDST: 9:15 - 5:45 EDST: 9:15 - 5:45 REGION VI REGION VIII Mr. Loerance Deaver RSA Regional Commissioner RSA Regional Commissioner 06-5050 08-7050 Dept. of Ed., Dept. of Education, OSERS Federal Office Bldg. 1200 Main Tower Bldg., Rm. 2140 Suite 310 Dallas, TX 75202 1244 Speer Boulevard 9-1-214-767-2961 Denver, Co 80204-3582 Fax: 9-1-214-767-8127 9-1-303-844-6078 TDD: 9-1-214-767-8125 Fax: 9-1-303-844-6269 RSA BB USER-ID: RSARCVI TDD: 9-1-303-844-2890 -- Arkansas RSA BB USER-ID: RSARCVIII -- Louisiana -- Montana -- New Mexico -- N. Dakota -- Oklahoma -- S. Dakota -- Texas -- Utah -- Wyoming Hours: 8:00 - 4:30 -- Colorado EDST: 9:00 - 5:30 Hours: 7:30 - 4:00 EDST: 9:30 - 6:00 REGION IX REGION X Mr. Gilbert Williams RSA Regional Commissioner RSA Regional Commissioner 09-8050 10-9050 Dept. of Education, OSERS Dept. of Education, OSERS Federal Office Bldg., Room 215 915 Second Avenue, Room 50 United Nations Plaza 2848 San Francisco, CA 94102 Seattle, WA 98174-1099 9-1-415-556-7333 9-1-206-220-7840 Fax: 9-1-415-556-3634 Fax: 9-1-206-220-7840 TDD: 9-1-415-556-3323 TDD: 9-1-206-220-7849 RSA BBS USER-ID: RSARCIX RSA BBS USER-ID: RSARCX -- Arizona -- Alaska -- Hawaii -- Idaho -- Nevada -- Oregon -- Guam -- Washington -- American Samoa -- California Hours: 8:00 - 4:30 -- CNMI EDST: 11:00 - 7:30 -- Palau EDST: 11:00 - 7:30 Hours: 8:00 - 4:30 CENTRAL OFFICE DIRECTORY John Nelson Dr. Donald Thayer Branch Chief Program Specialist Independent Living Branch Independent Living Branch Special Projects Division Special Projects Division Office of Developmental Office of Developmental Programs, RSA Programs, RSA 330 C St., S.W., 330 C St., S.W., Room 3326 Room 3320 Washington, DC 20202-2741 Washington, DC 20202-2741 TEL: 202-205-9362 (V)(TDD) TEL: 202-205-9315 Fax: 202-205-9772 Fax: 202-205-9772 RSA BBS USER ID: JNELSON INTERNET: john nelson@ed.gov Hours: 8:00 - 4:30 Hours: 8:00 - 4:30 UNITED STATES DEPARTMENT OF EDUCATION OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES REHABILITATION SERVICES ADMINISTRATION Washington, D.C. 20202-2741 FISCAL YEAR 19 ANNUAL PERFORMANCE REPORT FOR STATE INDEPENDENT LIVING SERVICES PROGRAM CENTERS FOR INDEPENDENT LIVING PROGRAM PART I STATE CHAPTER 1, TITLE VII OF THE REHABILITATION ACT, AS AMENDED SUBPART IA - ADMINISTRATIVE DATA (704(m)(4)(D) of the Act; 34 CFR Parts 74 and 75) I - Resources (a) Federal Funds (1) Ch. 1, part B, Title VII $ (2) Ch. 1, part C, Title VII (723 States) $ (3) Ch. 2, Title VII $ (4) Other Federal Funds $ (b) Other Government Funds (5) State government funds $ (6) Local government funds $ (c) Private Resources (7) Foundation, corporation or trust grants $ (8) Donations from individuals $ (9) Memberships $ (10) Investment income, endowment $ (11) Fees for service (program income) $ (12) Other resources (in-kind items, etc.) $ (estimated fair market value) (d) Total resources (Sum of lines 1--12) $ (e) Amount of total resources that "pass through" to consumers, e.g., personal assistant service funds $ (f) Net operating resources (line (d) minus line (e)) $ II - Allocation of Funds Part B, Ch. 1 Funds (from SPIL developed under 704, 713 of the Act; 34 CFR 365.20) Purpose $ Direct By DSU Grant or contract (a) Fund the resource plan for the SILC $ Y N Y N (b) Provide IL services directly or through grant or contract $ Y N Y N (c) Demonstrate ways to expand and improve IL services $ Y N Y N (d) Support the general operation of CILs $ N/A Y N (e) Support activities to increase capacity to develop approaches or systems for providing IL services $ Y N Y N (f) Conduct studies and analyses, gather information, develop model policies, and present information in order to enhance IL Services. $ Y N Y N (g) Train regarding IL philosophy $ Y N Y N (h) Provide outreach to unserved or underserved populations, including minority groups and urban and rural populations. $ Y N Y N III - Provision of Services (704(e) of the Act; 34 CFR 365.20.21) (a) If the DSU provides community IL services using part B funds, directly or through grant or contract to a service provider other than a CIL reporting in 704 Part II, complete Subpart IC(I) of this part. (b) If the DSU directly provides IL services to individuals with significant disabilities; directly determines eligibility for such individuals; and the CSRs for those individuals are maintained outside a CIL reporting in 704 Part II, enter information on such individuals in Subpart IB of this part and complete Subpart IC(II) of this part. IV - Grants, Contracts or other Arrangements for Use of Part B Funds (704(f), 713 of the Act; 34 CFR 365.23) (a) Grantee/Contractor Use of Funds (from tbl IA-II) Part B Ch. 1 $ Other Federal $ Nonfed Sources $ (1) $ $ $ (2) $ $ $ (3) $ $ $ (4) $ $ $ (5) $ $ $ Total Amount of Grants/Contracts $ $ $ Attachment I - A (34 CFR 364.43(e)) (If all grants/contracts for services are for the general operation of CILs, skip this section) (a) If the purpose of any grant or contract is to provide IL services to individuals: (1) Who determines eligibility for these individuals? (2) Where is the CSR for each individual maintained? (b) For grants or contracts for purposes other than services, please provide a brief narrative description of the objectives to be achieved by each agreement, what activities were conducted during the year; and what results were achieved. V - Staffing (21, 701, 704(m)(2) of the Act; 34 CFR 364.35, 34 CFR 364.36) Report the total number of FTE employed in the SILS and CIL programs by the DSU(s) and by service providers other than CILs reporting in Part II. Report the total decisionmaking and other staff, the number of FTE filled by individuals with disabilities, and the number of minority FTE who are employed. Total Persons Number SILS/CIL program FTE with who are Disabilities Minority (a) Decisionmaking staff (b) Other staff SUBPART IB: NUMBERS AND TYPES OF INDIVIDUALS WITH SIGNIFICANT DISABILITIES RECEIVING SERVICES EITHER DIRECTLY FROM THE DSU OR THROUGH GRANTS OR CONTRACTS. (13, 704(m)(4)(B), (D) of the Act; 34 CFR 364.53) I - Consumers Served during Year (a) CSRs carried from previous FY (b) CSRs started since Oct. 1 of report year (c) Total consumers served II - Consumers Inactive @ Sept. 30 (a) Moved (b) Withdrew (c) Died (d) Inactive because goals met (e) Other (f) Total inactive III- Consumers (CSRs) Active @ Sept. 30 (I(c) minus II(f)) IV - Time Consumer (CSR) active (a) Less than 12 months (b) 12 months - 2 years (c) 2 years - 5 years (d) Over 5 years (e) Total V - Consumer Achievements (725(c)(14) of the Act; 34 CFR 364.43) (a) Number of individuals to whom an offer was made to develop an ILP but who waived the offer (b) Number of individuals with whom an ILP was developed during the year. Consumer Goals and Objectives Established and Achieved Objectives/Goals Total Goals set Total Goals met (a) Self-care (b) Communication (c) Mobility (d) Residential (e) Educational (f) Vocational (g) Other VI - Age (a) Under 6 (b) 6 - 17 (c) 18 - 22 (d) 23 - 54 (e) 55 & over VII - Gender (a) Female (b) Male VIII - Race/ethnicity (a) White (non-Hispanic) (b) Black (non-Hispanic) (c) American Indian or Alaskan Native (includes Native Hawaiian) (d) Asian or Pacific Islander (e) Hispanic IX - Disability (a) Cognitive (b) Mental (c) Physical (d) Sensory (e) Multiple disability X - Living Arrangements CSR @ Sept. 30 (a) Institution (b) Dependent w/family or friends (c) Assisted living (d) Independent (e) Other XI - Source of Personal Assistance Services Reimbursement CSR @ Sept. 30 (a) Part B, Ch. 1, Title VII (b) Part C, Ch. 1, Title VII (c) Medicaid Waiver Program (d) Medicaid (e) Title XX (f) Other (g) None Available SUBPART IC: TYPES OF SERVICES PROVIDED AND THE NUMBER OF INDIVIDUALS WITH SIGNIFICANT DISABILITIES RECEIVING EACH TYPE OF SERVICE (704(m)(4)(D), 725(c)(8)(C) of the Act; 34 CFR 364.43, 366.50(I)(3)) (Reporting the number of hours of Community Services performed is optional.) I - Community services Total Hours Conducted (Y/N) (a) Information and referral (b) Community and systems advocacy (c) Outreach (d) Publications (e) Community education (f) Maintaining registries (g) Other (h) Total (a - g) II - Individual services No. of Persons Served (a) Advocacy/legal services (b) Assistive devices/equipment (c) Children's services (d) Communication services (e) Counseling and related services (f) Family services (g) Housing and shelter services (h) Information and Referral (I) Independent living skills training and life skills training and services (j) Mental restoration (k) Mobility training (l) Peer counseling (including cross-disability peer counseling) (m) Personal assistance services, including attendant care and the training of personnel providing such services (n) Physical rehabilitation (o) Preventative services (p) Prostheses and other appliances (q) Recreational services (r) Rehabilitation technology (s) Therapeutic treatment (t) Transportation services (v) Youth services (w) Vocational services (x) Other SUBPART ID: STATEWIDE INDEPENDENT LIVING COUNCIL (SILC) REPORT (705(c)(5) of the Act; 34 CFR 364.21(g)) ATTACHMENT I - D(a) - In the attachment please address the following, as appropriate: I General Activities Please provide a summary of activities the SILC has been involved in during the reporting year such as: o Problems encountered and how they were addressed; o Relations with the DSU(s), activities, problems, solutions; o Allocation of resources and development of the State plan; o Other information that the SILC believes would be helpful or informative to RSA, the Congress, and other CILs and State agencies. Please be brief and concise, but complete, in your response. II Design for Network of Centers Coordinate with the DSU(s) and report on: o The development and implementation of the design for a statewide network of CILs, with particular emphasis on-- - Underserved and unserved areas. - Priorities for establishment of new centers. - Estimated resources needed to accomplish each step of the design. o How the needs and resources were determined, the numbers of individuals with significant disabilities unserved or underserved, and other data supported by surveys available in the State. III Evaluation by SILC (a) Provide a summary of-- o The SILC's evaluation activities related to implementation of the State plan. o Findings and recommendations related to any problems encountered in implementation of the State plan. o Council participation in any on-site compliance reviews of CILs. o Involvement in development of corrective action plans addressing deficiencies of CILs, etc. The summary should include positive evaluation findings as well as negative findings. Exemplary activities, particularly those the council considers worthy of replication, and incidences of substantial deviation from provisions in the State plan should be noted. (b) Describe activities and results related to evaluation of the effectiveness of the State plan in meeting the objectives established in the plan, including evaluation of satisfaction by individuals with significant disabilities. ATTACHMENT I - D(b): TRAINING AND TECHNICAL ASSISTANCE NEEDS (Section 721(b)(3) of the Act; 34 CFR 366.13) As the SILC reviews the performance of the entities and service providers involved in the implementation and administration of the State plan during the reporting year, and the needs of the SILC in carrying out its responsibilities in the next fiscal year, please identify and prioritize the SILC's training and technical assistance needs for the next fiscal year. In this attachment, the SILC may also identify training and technical assistance needs of CILs providing services in the State, resulting from the SILC's evaluation and monitoring activities. (721(b)(3) of the Act) IV - Composition of the Council (1) State the total number of persons on the Council. (2) State number of Council members with disabilities (3) State the number of persons on the Council who are ex-officio (non-voting) representatives from State agencies (4) State the number of persons on the Council who represent or are employed by CILs (5) State the number of voting members on the Council (6) State number of Council members with disabilities not employed by a CIL or any State agency (7) Number of different disability groups (physical, mental, cognitive, or sensory) represented by members of the Council (7) Does the Council includes members from minority groups? Y N (8) Does the council have a voting membership that is knowledgeable about CILs? Y N (9) Do Council members provide statewide representation? Y N (10) Is the Council Chairperson elected from among the voting members of the Council by the voting members of the Council? Y N V - Placement of the SILC (Sec. 705(a) of the Act; 34 CFR 364.21(a) Following is a brief description of the status and placement of the SILC. SUBPART IE: DSU(s) ACTIVITIES (704(m)(4)(D) of the Act; 34 CFR 364.22, 364.38) ATTACHMENT I - E - In the attachment please address the following, as appropriate: I - Development of the SPIL and Provision of Administrative Support Services. I - Evaluations Conducted by DSU(s). (a) Summarize results of evaluation activities conducted by the DSU(s) during the reporting year, including positive and negative findings. (b) Describe any evaluation activities jointly conducted with the SILC related to implementation of the Evaluation plan required by 704(n) of the Act. II - Monitoring. (a) A summary of monitoring activities conducted by the DSU(s), (including involvement or coordination with the SILC) with findings of strengths and weaknesses in the implementation of activities conducted under the SPIL. (b) In 723 States only: (1) Identify each CIL that was the subject of a on-site compliance review during the reporting year and provide information on the extent to which the CIL complied with the standards in 725. Where a particular CIL has exemplary and innovative practices that may be replicated by other CILs, RSA encourages the DSU to describe the practice. (723(g) of the Act; 34 CFR 366.38) (2) Provide a summary of periodic reviews, other than on-site reviews conducted of CILs compliance with the standards and assurances in 725. (3) Provide a summary of any corrective action plans developed as a result of findings of noncompliance. (723(f) of the Act; 34 CFR 366.38). (4) Identify any CILs against which adverse action was initiated pursuant to 723(h) of the Act. SUBPART IF: NARRATIVE - COMPARISON WITH PRIOR YEARS (704(m)(4)(D), 705(c)(5) of the Act; 34 CFR 366.50(I)(7)) ATTACHMENT 5 - In this attachment please provide: (a) Additional information, comments, or explanations of the reporting year data compared to the previous year. (b) Descriptions of significant activities not accounted for elsewhere in the report, e.g., brief summaries of innovative activities or practices, not reported in previous years, which could be replicated and used by other States and CILs. (c) Descriptions of substantial problems or difficulties, types of resolution methods attempted, and which ones worked (Why?). (d) A comparison of program accomplishments and goal achievements during this reporting year with the immediately preceding reporting year . MAIL ONE COPY OF THIS REPORT TO YOUR RSA REGIONAL OFFICE, AND ONE COPY TO THE RSA CENTRAL OFFICE. SIGNATURE OF STATE AGENCY OFFICIAL DATE NAME AND TITLE OF STATE AGENCY OFFICIAL PHONE NUMBER SIGNATURE OF STATE AGENCY OFFICIAL DATE NAME AND TITLE OF STATE AGENCY OFFICIAL PHONE NUMBER SIGNATURE OF SILC REPRESENTATIVE DATE NAME OF SILC REPRESENTATIVE PHONE SECTION 704 PERFORMANCE REPORT INDEPENDENT LIVING PROGRAMS Chapter 1, Title VII Part II 7/7/95 Rehabilitation Act of 1973, as amended TABLE OF CONTENTS GENERAL INSTRUCTIONS I PART II SUBPART IIA: SELF EVALUATION COMPLIANCE INDICATOR 1 - PHILOSOPHY II-3 I - Consumer control II-3 II - Self-help and self-advocacy II-3 III - Development of peer relationships and peer role models II-3 IV - Equal access II-4 COMPLIANCE INDICATOR 2--CROSS-DISABILITY II-5 COMPLIANCE INDICATOR 3--INDEPENDENT LIVING GOALS II-5 COMPLIANCE INDICATOR 4--COMMUNITY OPTIONS AND COMMUNITY CAPACITY II-6 COMPLIANCE INDICATOR 5--INDEPENDENT LIVING SERVICES II-6 COMPLIANCE INDICATOR 6--RESOURCE DEVELOPMENT ACTIVITIES II-7 SUBPART IIB: NARRATIVE - COMPARISON OF THE ACTIVITIES OF THE CIL IN PRIOR YEARS WITH THE ACTIVITIES IN THE MOST RECENT YEAR II-7 ATTACHMENT II - B - Narrative SUBPART IIC: PROGRAM AND FINANCIAL PLANNING OBJECTIVES II-8 ATTACHMENT II - C(a) - Next Fiscal Year Work Plan ATTACHMENT II - C(b) - Technical Assistance and Training Needs SUBPART IID: SOURCES AND AMOUNTS OF FUNDING FOR THE OPERATION OF THE CIL I - Resources II-9 SUBPART IIE: NEXT FISCAL YEAR BUDGET INFORMATION I - Form 524 II-11 SUBPART IIF: NUMBERS AND TYPES OF INDIVIDUALS WITH SIGNIFICANT DISABILITIES RECEIVING SERVICES THROUGH THE CIL I - Consumers Served during Year II-13 II - CSRs Inactive @ Sept. 30 II-13 III- CSRs Active @ Sept. 30 II-13 IV - Time CSR active II-13 V - Consumer Achievements II-14 VI - Age II-14 VII - Gender II-14 VIII - Race/ethnicity II-14 IX - Disability II-15 X - Living Arrangements CSR @ Sept. 30 II-15 XI - Source of Personal Assistance Services Reimbursement CSR @ Sept. 30 II-15 SUBPART IIG: TYPES OF SERVICES PROVIDED THROUGH THE CIL AND THE NUMBER OF INDIVIDUALS WITH SIGNIFICANT DISABILITIES RECEIVING EACH TYPE OF SERVICE I - Community services - Total Hours II-16 II - Individual services - No. of Persons Served II-16 OMB Number: 1820-0606 EXPIRATION DATE: 9/30/98 UNITED STATES DEPARTMENT OF EDUCATION OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES REHABILITATION SERVICES ADMINISTRATION WASHINGTON, D.C. 20202-2741 INSTRUCTIONS FOR COMPLETION AND SUBMITTAL OF THE SECTION 704 ANNUAL PERFORMANCE REPORT PURPOSE OF THE REPORT The purpose of this report is to: (a) Serve as a performance measuring instrument of independent living (IL) programs, both quantitatively and qualitatively; (b) Determine the training and technical Assistance needs of Centers for Independent Living (CILs) as required by section ()721(b)(3) of the Rehabilitation Act of 1973, as amended (Act); (c) Determine CIL compliance with the standards, assurances, and indicators of compliance with the standards in 725 of the Act and 34 CFR Part 366; (d) Collect information necessary for issuance of continuation awards for qualified CILs funded under the CIL program; (e) Collect the data required by 13, 706, 721, and 725 of the Act for the State Independent Living Services and the Centers for Independent Living (CIL) programs; and (f) Serve as the basis for on-site reviews of the Chapter 1, Title VII of the Act program grantees. The report is structured to: (a) Establish a uniform reporting system to compile an accurate national report on independent living; (b) Provide a performance based, program specific, report sufficient to process continuation awards for 722 of the Act grantees; and (c) Enable each State to have information on all funds expended for IL in the State, for what the funds paid, who was served, with what services, and for RSA to be able to compare State and CIL performance with other States and other CILs. (Authority: 13, 704(m)(4)(D), 705(c)(5), 706(d), 721, 722, 723, 725(c)(8), 725(c)(13) of the Act; 34 CFR Parts 364, 365, 366) Each CIL receiving funds under part B (for the general operation of the CIL) or part C of must complete the Part II report. A list of RSA regional and central office contacts, addresses, telephone numbers, and electronic contact user IDs, is included at the end of these instructions. GLOSSARY OF TERMS Act The Rehabilitation Act of 1973, as amended CIL A "Center for Independent Living" meeting the definition in 702 of the Act, and the standards in 725 of the Act. CIL program The "Centers for Independent Living program" funded under part C, Chapter 1 (Ch. 1) of Title VII of the Act (part C). Consumer Any individual with a significant disability who is eligible for IL services under 34 CFR 364.40(a) and is currently receiving or has been provided with any IL services under the program other than information and referral. Core Services IL services defined in 7(29) of the Act--information and referral, IL skills training, peer counseling (including cross-disability peer counseling), and individual and systems advocacy. CSR A "Consumer Service Record" maintained for an eligible consumer receiving IL services and meeting the requirements of 34 CFR 364.53. Where IL services are provided to the parent or guardian of a consumer, the CSR is established for the consumer and the services provided are reflected in that CSR. DSU The "Designated State Unit, or Units" identified under 101(a)(1) of the Act, to jointly with the Statewide Independent Living Council, develop and sign the State plan for Ch. 1 of Title VII under 704 of the Act. The term includes a State agency solely designated under State law to provide IL services to individuals who are blind. In such State, the State agency for the Blind may administer the provisions in the attachments to the State plan providing for services to individuals who are blind. In a "723 State", the DSU administering the CIL program is always the general agency. Earmarked Funds appropriated by the State and expressly or clearly identified as State Funds expenditures in the relevant fiscal year for the sole purpose of funding the general operation of CILs meeting the requirements of 702 and 725 of the Act. 722 State A State where RSA issues grants under part C directly to eligible agencies (CILs). 723 State A State where the DSU issues grants or assistance contracts under part C to eligible entities for the planning, establishment, and operation of CILs. IL "Independent Living" ILP An "Independent Living Plan" for the provision of IL services mutually agreed upon by an appropriate staff member of a service provider and an individual with significant disabilities. Minority Means Alaskan Natives, American Indians, Asian Americans, Black (African Groups Americans), Hispanic Americans, Native Hawaiians, and Pacific Islanders. Reporting The most recent Federal fiscal project year completed - October 1 to September 30. Year RSA The "Rehabilitation Services Administration" in the Department of Education, Office of Special Education and Rehabilitative Services. Service Provider-- (I) A DSU which directly provides IL services to consumers; or (ii) A CIL; or (iii) An entity which: (A) provides IL services under a grant or contract; and (B) is delegated responsibility for the determination of eligibility for IL services. SILC The "Statewide Independent Living Council" established in each State as required by 704 and 705 of the Act. SILS The "State Independent Living Services program" funded under part B, Ch. 1 of Title VII of the Act. SPIL The "State Plan for Independent Living," which governs the State IL Services and Centers for Independent Living programs and describes the services to be provided under the IL Services for Older Individuals who are Blind program. STATE Wherever the term "State" is used, it refers to the State in its sovereign sense. For purposes of Title VII, the DSU(s) and the SILC jointly represent the State, except where otherwise noted. CONTENT OF THE REPORT 704 REPORT, PART II (Part II) contains: (a) Subpart IIA - Self Evaluation: a measure of the extent to which a CIL is in compliance with the standards in 725(b) of the Act and the indicators of minimum compliance with the standards in 34 CFR Part 366, Subpart G; (b) Subpart IIB: Narrative - Comparison of the Activities of the CIL with the Reporting Year Work Plan and with the Activities in the Year Immediately Preceding the Reporting Year (1) A comparison of activities and accomplishments during the reporting year with the goals and activities included in the reporting year's work plan; (2) A comparison with the immediately preceding reporting year of program accomplishments and goal achievements during the reporting year; (3) Descriptions of significant activities not accounted for elsewhere the report, e.g., brief summaries of innovative activities or practices not reported in previous years, which could be replicated and used by other States and CILs; (4) Descriptions of substantial problems or difficulties, particularly problems that may affect compliance, alternative resolutions explored, and which ones worked (Why?); (c) Subpart IIC - Program Planning Objectives: a report on compliance with the assurance that a CIL will establish annual and 3-year work plans and the CIL's work plan for the next fiscal year; (d) Subpart IID - Sources and Amounts of Funding for the Operation of the CIL: a report on resources received and expended by a CIL during the reporting year; (e) Subpart IIE - Next Fiscal Year Budget Information: submittal of budgets for the remaining years of the grant where budgets have not been previously negotiated, or a revised budget where appropriate; (f) Subpart IIF - Consumer Demographics: provides information from CSRs controlled by the CIL (i.e., maintained in a CIL required to report in 704 Part II) on the numbers and types of consumers receiving IL services, regardless of the source of funding for a particular service; and (g) Subpart IIG - Types and Amounts of Services Provided: a report of community (Subpart IGI) and individual (Subpart IIGII) IL services provided by the CIL. Information on individual services is reported only from CSRs controlled by the CIL, regardless of the source of funding for a particular service. WHO MUST COMPLETE THE REPORT AND WHERE MUST IT BE SUBMITTED? (a) Section 722 State. (1) The part C and part B funded CILs will submit one copy of the Part II report to the RSA regional office, one copy to the RSA central office, and one copy to the SILC. If the CIL is receiving both part B and part C funds, also submit a copy of the report to the DSU. (2) CILs funded solely with part B or State funds submit their Part II reports to the DSU and the SILC. The DSU will transmit the CIL reports to RSA with the Part I report. (b) Section 723 State. CILs will file their Part II reports with the DSU and the SILC. The State will aggregate the data and summarize other information in the Part II reports with the Part I report and attach the incoming reports from the CILs for reference, including the State's Technical Assistance and Training Needs Survey. The aggregate Part I report will be forwarded to RSA (one copy to the regional office, one copy to RSA central office). A list of RSA regional and central office contacts, addresses, telephone numbers, and electronic contact user IDs, is included at the end of these instructions. WHEN MUST THE REPORT BE SUBMITTED TO RSA? (a) In 722 States, the Part II reports from part C funded CILs are due to RSA 90 days after the end of the reporting year (December 29). (b) In 723 States, the information from the Part II reports is included in the aggregate Part I report, which is due to RSA 90 days after the end of the reporting year (December 29). TRANSMITTING THE REPORT ELECTRONICALLY RSA will transmit to all States and CILs computer software to enable States and CILs to file the 704 Reports by computer on the RSA Bulletin Board (RSA BBS). Please send original signature pages to the appropriate RSA regional office. To file: RESERVED INSTRUCTIONS FOR ELECTRONIC FILING UNDER THE ELECTRONIC REPORTING SYSTEM UNDER DEVELOPMENT WILL BE TRANSMITTED TO YOU ALONG WITH THE REPORTING SOFTWARE. RECORD RETENTION The information provided in this report by Federal grantees is subject to confirmation at an on-site compliance review; therefore, financial records, statistical records, and all supporting documents and other records pertinent to the grant award, adequate to document the accuracy of the information and statements in the 704 Annual Performance Report, must be kept for five years. (Authority: 34 CFR 74.53) INSTRUCTIONS FOR COMPLETING THE 704 ANNUAL PERFORMANCE REPORT SELF-EVALUATION (Part II, Subpart IIA, IIB) The purpose of the self evaluation is to assist the CIL to assess the CIL's compliance with the standards in 725(b) and the indicators of minimum compliance with the standards in 34 CFR Part 366, Subpart G; and the assurances in 725(c) and 34 CFR Part 366, Subpart F. The standards, indicators, and assurances are requirements reflecting essential elements that a CIL must meet to comply with the statutory definition of a CIL and to be eligible for continuation funding. This subpart and the instructions for the narrative in Subpart IIB provide guidance against which a CIL should review its activities to determine whether or not it may have a problem complying with the standards in the event of an on-site compliance review under Section 706(c) or 723(g) and (h) of the Act. If the CIL does identify problems, it should address them in the manner suggested in paragraph (c). (702, 722(c), 723(c), 724(a)(2) of the Act; 34 CFR Parts 364 and 366) If a CIL determines through its self evaluation that it may have a problem meeting one of the standards or an assurance, it should note in the Part II report either: (a) What action has been taken since the end of the reporting year to correct the deficiency (Attachment II-B); or (b) Include in next year's work plan, a description of the corrective action the CIL proposes to take to correct the deficiency (Attachment II-C(a)). (34 CFR Part 366, Subpart E) Staffing Part II, Subpart IIAI(a)(1) (1) "FTE" means one person working full-time equivalent of one year (Approximately 2080 hours). Part-time employees and employees who worked for any fraction of the year are counted as a fraction of an FTE to the nearest tenth. (2) To compute FTE for purposes of the 704 report, determine the number of hours (excluding any overtime) for which employees were actually paid during the last six months of the reporting year. Multiply the hours worked by 2 and then divide the result by 2080 = FTE. (3) Categories of positions are: (I) Decisionmaking - e.g., executive director, supervisors, and any other policy position; (ii) Staff - e.g., counselors, teachers, trainers, and other staff not included in (3)(I). ATTACHMENT II - B - CIL Narrative (Reporting and prior year) Please do not report information in this attachment that is included elsewhere in the report. In the following order please describe or discuss: (a) Activities and accomplishments during the reporting year; compare with the goals and activities included in the reporting year's work plan. Briefly discuss how the activities compare with the activities of the CIL in the year immediately preceding the reporting year, if appropriate. Please refer to the section(s) of the self-evaluation (Part II, Section IIA Indicators) with which the activities and accomplishments demonstrate compliance. Address in order-- (1) Advocacy, including but not limited to: (I) Community and systems advocacy plan; (ii) Technical assistance plan; (iii) Communication, coordination, and cooperation (collaboration plan); and (iv) Affirmative action plan. (Sec. 725(b)(5) and (6) of the Act; 34 CFR 366.50; 704II, Sections IIA(I)(d)(2), (IV)) (2) Outreach. Describe the CIL's outreach activities to consumers who are members of populations of individuals with significant disabilities, including minorities, who are unserved or underserved. (Sec. 725(b)(6) of the Act; 704II, Section IIA(IV)) (3) Community and individual IL service needs. In addition to your report on work plan activities in this area, provide a brief (one paragraph) summary of the type of opportunities provided consumers to express satisfaction including the number of individuals assessed and the number of respondents. Also, indicate any planned needs assessment of individuals with significant disabilities living in the service area. Please describe the type of assessment approach, e.g., focus group, written survey, public meeting, etc. (Sec. 725(b)(5) of the Act; 704II, Section IIA(V)) (4) Response to community or individual needs. Report on the response to opportunities provided by the CIL for consumers to express satisfaction with the CIL's services in (3) preceding and policies in facilitating their achievement of IL goals. Also, if the CIL included in its last year's work plan activities responding to a community needs assessment or consumer satisfaction surveys, please report on the results of the activities. (Sec. 725(b)(6) of the Act) (4) Resource development. If the information is available, please report the percentage and dollar amount of the CIL's total funding represented by resources received from sources other than Title VII of the Act. Please note any exemplary replicable methods of resource development. (Sec. 725(b)(7) of the Act; 704II, Section IIA(VI)) (5) Training. Please provide a brief report on staff and governing board training activities during the reporting year. (Sec. 725(c)(11) of the Act; 34 CFR 364.24) (b) Significant activities not accounted for elsewhere in this report, e.g., brief summaries of innovative activities or practices not reported in previous years, which could be replicated and used by other States and CILs. (c) Descriptions of substantial problems or difficulties, particularly problems that may affect compliance, types of resolution methods attempted, and which ones worked (Why?). If a corrective action plan is included in next year's work plan, please cross-reference it here (no need to describe it). ATTACHMENT II - C(a) - CIL work plan This attachment is to contain information an eligible CIL must provide to qualify for continued funding under the CIL program; therefore it is important that the attachment be carefully and completely prepared. Failure to complete the attachment may jeopardize the CIL's part C grant award. This attachment contains the CIL's work plan for the next Federal fiscal year. The plan should be specific and measurable so that, at the end of the reporting year, the CIL can compare its achievements against its projected goals and the indicators in Part II, Subpart IIA. If a corrective action plan, necessary to correct a compliance problem identified by the CIL, is included in the work plan, it should be specifically identified and cross-referenced to the specific standard or indicator in Part II, Section IIA. The work plan should include, but not be limited to: Goals and activities. Include long term goals and specific activities planned to meet the requirements of each of the standards in section 725 of the Act including the following: (a) Advocacy. Include details of how the CIL will achieve its social change goals including: (1) A community advocacy plan and related activities; (2 ) A technical assistance plan and related activities; (3) A plan for collaboration with other agencies and groups to further communication, coordination, and cooperation along with related activities; and (4) Affirmative action plans. (b) Outreach. Describe the CIL's plans for outreach to consumers who are members of populations of individuals with significant disabilities, including minorities, who are unserved or underserved. To comply with the standards and indicators, CILs are not required to conduct a needs assessment; however, the Department considers needs assessments to be a useful tool to identify unserved and underserved populations, to ascertain their needs, identify existing resources available and additional resources needed to address the needs. Needs assessment need not be undertaken every year but are believed to lose substantial utility after three years. The Department suggests that any needs assessment undertaken: (1) Be based on methodology that is consistent with statewide needs assessment methodologies adopted by the SILC and the DSU; and (2) Identify the-- (I) Service needs of individuals with significant disabilities, including the numbers of individuals with different types of physical, cognitive, mental, and sensory disabilities in the community; (ii) Barriers to full integration of individuals with significant disabilities into society; and (iii) Resources available or necessary to remove those barriers. If the CIL conducted a needs assessment during the reporting year, RSA recommends that CILs summarize the results and provide the summary to the CIL's governing board, SILC, and include the summary in Part II, Attachment II-B(4). (c) Community and individual IL service needs. Identify the community and individual IL services the CIL anticipates providing. Ensure that the intended services are consistent with the approved SPIL. CILs are required to provide opportunities for consumers to express satisfaction with the CIL's services and policies in facilitating their achievement of IL goals. The purpose of this indicator is to assure that a CIL is currently providing needed services in an appropriate manner and to identify needs for additional or different services. In addressing this requirement CILs: (1) Should afford consumers an opportunity to anonymously express satisfaction or dissatisfaction with the effectiveness of the CIL's services and policies in facilitating consumers' achievement of IL goals; (2) May use various approaches such as town meetings, focus groups, written surveys, and telephone surveys; (3) Must report the results to the CIL's governing board, SILC, and include a brief summary of the results in Part II, Attachment II-B. (d) Response to needs. Identify in the work plan, if appropriate, workplan provisions specifically responsive to any recent community needs assessment, consumer expressions regarding satisfaction, or needs identified through any other forum. Provisions could include: (1) Making adjustments in the CIL's resource allocations to meet consumer needs identified; (2) Inclusion in the plan, advocacy for the creation of new programs that will expand the options available to consumers, as identified; and (3) A corrective action plan addressing specific deficiencies in the CIL's activities or operation, identified. (e) Resource development. Include the CIL's goals and activities for obtaining and increasing funding (including in-kind) from sources other than Title VII of the Act. RSA particularly encourages CILs to set goals to increase funding received by the center from sources other than Title VII of the Act by setting a percentage target increase related to the CIL's anticipated funding from all sources for the next year. (Sec. 725(b)(7) of the Act; 704II, Section IIA(VI)) (f) Training. Include plans for training governing board, employees, volunteers, and consumers; e.g., staff development, IL philosophy, ADA, particularly specific activities to train consumers in self-advocacy and personal power. (34 CFR 364.24) ATTACHMENT II - C(b) - CIL training and technical assistance needs As the CIL compares its last fiscal year's work plan and accomplishments, conducts its self-evaluation of compliance with the indicators, and considers what is required to accomplish the next year's work plan, the CIL should identify training and technical assistance needs for the next fiscal year. Please be specific. Identify and list these needs in priority order. (721(b)(3) of the Act; 34 CFR 366.13) SOURCES AND AMOUNTS OF RESOURCES (Part II, Subpart IID) In IID, report the amounts of resources received during the reporting year by the CIL from each of the sources indicated. ATTACHMENT II-E: ED FORM NO. 524 - BUDGET PROPOSAL A CIL that has negotiated a budget for each year of its grant award is not required to submit this budget proposal unless certain changes are anticipated in the budget for the upcoming year. Budgetary and other changes which require RSA's approval are specified in 34 CFR 74.103, 74.105, 74.176, and 80.30 of EDGAR. INSTRUCTIONS FOR ED FORM NO. 524 General Instructions This form is used to apply to individual U. S. Department of Education discretionary grant programs. Unless directed otherwise, provide the same budget information for each year of the multi-year funding request. Pay attention to applicable specific instructions, if attached. Section A - Budget Summary U. S. Department of Education Funds All applicants must complete Section A and provide a breakdown by the applicable budget categories shown in lines 1-11. Lines 1-11, columns (a)-(e): For each project year for which funding is requested, show the total amount requested for each applicable budget category. Lines 1-11, column (f): Show the multi-year total for each budget category. If funding is requested for only one project year, leave this column blank. Line 12, column (a)-(e): Show the total budget request for each project year for which funding is requested. Line 12, column (f): Show the total amount requested for all project years. If funding is requested for only one year, leave this space blank. Section B - Budget Summary Non-Federal Funds If you are required to provide or volunteer to provide matching funds or other non-Federal resources to the project, these should be shown for each applicable budget category on lines 1-11 of Section B. Lines 1-11, columns (a)-(e): For each budget year for which matching funds or other contributions are provided, show the total contribution for each applicable budget category. Lines 1-11, column (f): Show the multi-year total for each budget category. If non-Federal contributions are provided for only one year, leave this column blank. Line 12, columns (a)-(e): Show the total matching contribution for each project year. Line 12, column (f): Show the total amount to be contributed for all years of the multi-year project. If non-Federal contributions are provided for only one year, leave this space blank. Section C - Other Budget Information Pay attention to applicable program specific instructions, if attached (1) Provide an itemized budget breakdown, by project year, for each budget category listed in Sections A and B. (2) If applicable to this program, enter the type of indirect rate (provisional, predetermined, final, or fixed) that will be in effect during the funding period. In addition, enter the estimated amount of the base to which the rate is applied, and the total indirect expense. (3) If applicable to this program, provide the rate and base on which fringe benefits are calculated. (4) Provide other explanations or comments you deem necessary. Budgetary and other changes which require RSA's approval are specified in 34 CFR 74.103, 74.105, 74.176, and 80.30 of EDGAR. NUMBERS AND TYPES OF INDIVIDUALS WITH SIGNIFICANT DISABILITIES RECEIVING SERVICES (Subpart IIF) I - Active Consumer Service Records--This is a count of individuals who were determined eligible for any part of the reporting year, and for whom a CSR was initiated. (a) Enter the number of active CSRs carried over from September 30 of the preceding year. (b) Enter the number of new CSRs initiated during the year. (c) Enter the total number of consumers served during the year. II Inactive Consumers at Year End--Record consumer records that have been purged from the active CSR file because the individual has moved, stated that he or she had no further interest in the program, died, achieved all goals set, or for other reasons. III Active Consumers and Year End--Indicate the total number of Consumers remaining active on September 30 of the reporting year (I(c) - II(f)). For the remaining sections of this subpart, RSA intends that the demographic information include all consumers served during the year. IV Time Consumers active--Enter the numbers of CSRs and the time since initiation. V Consumer Achievements--Report the total numbers of goals set by consumers during the reporting year and the number of goals achieved by consumers during the reporting year. Consumers may set and/or achieve more than one goal, and a goal may be set in one year and achieved in another. Please classify goals in the following categories: (a) Self-care - Goals to improve/maintain an individual's autonomy with respect to activities of daily living such as personal grooming and cleaning, toileting, meal preparation, shopping, eating, etc. (b) Communication - Goals involving either improvement in the consumer's ability to understand and acknowledge communication by others (receptive), or improvement in one's ability to produce verbal language, sign language and other communication (expressive). (c) Mobility - Goals to improve an individual's access to his life space, environment or community. This increase in access may occur by improving the person's own ability to move or transport himself or herself, or by allowing the consumer to be moved or transported by another person. (d) Residential - Goals that provide for change in living situations with increased autonomy for the individual with significant disabilities. (e) Educational - IL goals of an academic or training nature that are expected to improve the consumer's basic knowledge or increase his or her ability to perform certain skills. (f) Vocational - IL goals related to obtaining, maintaining, or advancing in employment. (g) Other - Other IL goals not included in the above categories. VI Age--Enter number of consumers in each age category at the end of reporting year. For CSRs put in inactive status during the year, use consumers' ages to be reached during the reporting year. VII Gender--Enter number of males and females served during the fiscal year. VIII Race/ethnicity--Enter a count of individuals by race or ethnicity. Information should be solicited on a voluntary basis. If unavailable, a consumer should be included in the group to which he or she appears to belong. If you don't know, leave it blank. For persons who are of mixed racial origin, use the category which reflects the individual's choice. The racial categories are: (a) White (non-Hispanic)--A person having origins in any of the original peoples of Europe, North Africa, or the Middle East. (b) Black (non-Hispanic)--A person having origins in any of the black racial groups of Africa. (c) American Indian or Alaskan Native (including Native Hawaiians)--A person having origins in any of the original peoples of North America or Hawaii, and who maintains cultural identification through affiliation or community identification. (d) Asian or Pacific Islander - A person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands. This area includes, for example, China, India, Japan, Korea, the Philippine Islands, and Samoa. (e) Hispanic - A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin. IX Disability--Enter a count of individuals with a significant cognitive, mental, physical, sensory, or multiple disability. X Living arrangements--Indicate the living arrangements of individuals at the end of the reporting year or when a consumer moved to inactive status. (a) Institution--individuals living in nursing homes, etc; Note that residing in an institution does not render an individual ineligible for IL services so long as the individual has the ability to function, continue to function, or move towards functioning independently in the family or community (which could include the nursing home). (b) Dependent: w/family or friends--individuals living with and dependent on family or friends; (c) Assisted Living--includes halfway house, group home, etc; (d) Independent--number of individuals who are independent, whether living alone or with family or friends; or (d) Other. XI Source of Personal Assistance Services Reimbursement--As this is a new service authorized in the 1992 Amendments to the Act and is a major IL service, data regarding the sources of funding for the service is needed for State and Federal planning and budget purposes. Please indicate the number of persons receiving PAS from the sources indicated. Where funds are administered by the service provider and "passed through" to the consumer, please report the amounts of these funds in the financial section of the report. TYPES OF SERVICES PROVIDED AND NUMBERS OF INDIVIDUALS RECEIVING SERVICES (Subpart IIG) I - Community services--Centers must indicate by responding "Y" for Yes and "N" for No next to the community services provided by the CIL. Centers are encouraged but not required to report the number of hours of community service provided. If the CIL maintains records sufficient to report the number of hours and chooses to report the number of hours, in the appropriate columns, record the total person hours of staff time expended on particular community service activities, e.g., hours spent working on an advertising campaign to raise community awareness of ADA. The intent is to obtain a count of the types and hours of all group/community services being provided. Please round to the nearest whole hour. (a) Information and referral (I&R), as a community service entails the provision of I&R to groups of individuals and does not necessitate initiating a CSR, e.g., speaking at the Rotary Club luncheon about ADA. The chief difference between this service and the I&R under individual services listed later is this service is provided to groups rather than one individual at a time. (b) Community and systems advocacy--efforts to implement local policy and legislation to make facilities, services and opportunities available/accessible to individuals with disabilities. (c) Outreach--efforts to locate and serve individuals with significant disabilities in the community. (d) Publications--accessibility guides, disability awareness brochures, ADA, how to advice, etc. (e) Community education--activities and information programs to enhance the community's awareness of disabilities and disability issues, e.g., local TV, radio, or newspaper campaigns. (f) Maintaining registries--includes activities related to creating and maintaining directories for personal assistants, recreation opportunities, accessible transportation, accessible housing, and other support services. (g) Other--Activities that do not fit in any of the above. II - Individual Services--List the number of consumers receiving each of the services offered during the reporting year. The numbers of individuals utilizing a service affords a measure of the benefits derived from that particular service made available by a service provider; it is not expected to equal the number of consumers, as a single individual may receive a number of different services. IL services include, but are not limited to the following: (a) Advocacy/legal services - advocacy and legal assistance and/or representation in obtaining access to those benefits, services and programs to which a consumer may be entitled. (b) Assistive devices/equipment - provision of specialized devices and equipment such as TDD's, wheelchairs and lifts, or provision of assistance to obtain these devices and equipment from other sources. (c) Children's services - IL services provided to a child under age six. (d) Communication services - services directed to enable individuals with significant disabilities to better communicate such as: interpreter services, including tactile interpreter services for deaf-blind individuals; training in communication equipment use; Braille training; and reading services. (e) Counseling services, include psychological, psychotherapeutic, and related services. (f) Family services - services provided to the family members of an individual with significant disabilities when necessary for improving the individual's ability to live and function more independently, or his or her ability to engage or continue in employment. Such services may include respite care. (Record the service in the consumer's CSR on behalf of whom services were provided to the family.) (g) Housing or shelter services, including services related to securing housing or shelter, adaptive housing services (including appropriate accommodations to and modifications of any space used to serve, or occupied by, individuals with significant disabilities). A CIL shall not provide housing or shelter as an IL service on either a temporary or long-term basis unless the housing or shelter is incidental to the overall operation of the CIL and is provided to any one individual for a period not to exceed eight weeks during any six-month period. (h) Independent Living Skills Training and Life Skills Services and Training - IL skills training is instruction to develop independent living skills in areas such as personal care, coping skills, financial management, social skills, and household management, including education and training necessary for living in the community and participating in community activities. Life skills training and services are independent living skills training and interpreter, and reader services for individuals with cognitive and sensory disabilities. (I) Information and referral services - individual I&R provided to a consumer and recorded in his or her CSR. (It is not necessary to record I&R in a CSR nor establish a CSR for an individual receiving only I&R services). The greater number of individuals receiving I&R services are when individuals receive single face-to-face contact or one or two telephone calls that may result in providing information verbally, disseminating printed material and/or referral to another source for services or further information. It may include a minor one-time service of such a nature that establishment of a CSR is not justified. Some service providers record I&R as strokes on an answering pad--others as phone minutes; some CILs create a CSR or other files for future contact and outreach. (j) Mental Restoration - psychiatric restoration services including maintenance on psychotropic medication, psychological services, and treatment management for substance abuse. (k) Mobility training - variety of services involved in assisting individuals with cognitive and sensory impairments to get around their homes and communities. (l) Peer Counseling - counseling, teaching, information giving, and similar kinds of contact provided by other individuals with disabilities. (m) Personal assistance services, including attendant care and the training of personnel providing such services. (n) Physical restoration - restoration services including medical services; therapeutic treatments, such as physical therapy, occupational therapy, speech, language and hearing therapy; health maintenance; eyeglasses and visual services; and prosthetic, orthotic and other assistive appliances and devices. (o) Preventative services - services intended to prevent additional disabilities, or to prevent an increase in the severity of an existing disability. (p) Prostheses and other appliances (See also Rehab technology) (q) Recreational services - provision or identification of opportunities for the involvement of individuals with significant disabilities in meaningful leisure-time activities; participation in community affairs and/or other recreation activities that may be competitive, active or quiet. (r) Rehabilitation technology - provision of, or assistance to obtain through other sources, adaptive modifications which address the barriers confronted by individuals with significant disabilities with respect to education, rehabilitation, employment, transportation, independent living and/or recreation. (s) Therapeutic treatment - services provided by registered occupational, physical, recreational, or speech therapists. (t) Transportation - provision of, or arrangements for provision of transportation. (u) Youth Services - services provided to youth with significant disabilities (ages 6 - 17); training to develop skills specifically designed for youths to promote self-awareness and esteem, develop advocacy and personal power skills, and explore career options. (v) Vocational services - any of the services defined in 103 of the Act. (w) Other - any IL service not listed above. RSA REGIONAL OFFICE DIRECTORY REGION I REGION III Mr. John J. Szufnarowski Dr. Ralph N. Pacinelli RSA Regional Commissioner RSA Regional Commissioner 01-0041 03-2050 Dept. of Education, OSERS Dept. of Education, OSERS J.W. McCormack Post Office 3535 Market St., Rm 16120 and Court House, Rm. 232 Philadelphia, PA 19104 Boston, MA 02109 9-1-215-596-0317 9-1-617-223-4085 Fax: 9-1-215-596-0471 Fax: 9-1-617-223-4573 TDD: 9-1-215-596-0269 TDD: 9-1-617-223-4097 RSA BBS USER-ID: RSARCIII RSA BBS USER-ID: RSARCI -- District of Columbia -- Connecticut -- Delaware -- Maine -- Maryland -- New Hampshire -- Virginia -- Rhode Island -- West Virginia -- Vermont -- Pennsylvania -- Massachusetts Hours: 8:00 - 4:30 Hours: 8:30 - 5:00 EDST: 8:00 - 4:30 EDST: 8:30 - 5:00 REGION II REGION IV RSA Regional Commissioner RSA Regional Commissioner 02-1050 04-3050 Dept. of Education, OSERS Dept. of Education, OSERS 26 Federal Plaza, Room 1239 101 Marietta St., N.W., New York, New York 10278 Suite 2210, P.O. Box 1691 9-1-212-264-4016 Atlanta, GA 30301 Fax: 9-1-212-264-3029 9-1-404-331-2352 TDD: 9-1-212-264-4028 Fax: 9-1-404-331-0494 RSA BBS USER-ID: RSARCII TDD: 9-1-404-730-3825 -- New Jersey RSA BBS USER-ID: RSARCIV -- Puerto Rico -- Alabama -- Virgin Island -- Florida -- New York -- Kentucky -- N. Carolina -- S. Carolina Hours: 8:00 - 4:30 -- Tennessee EDST: 8:00 - 4:30 -- Georgia -- Mississippi Hours: 8:00 - 5:00 EDST: 8:00 - 5:00 REGION V REGION VII Mr. Terry Conour RSA Regional Commissioner RSA Regional Commissioner 07-6050 05-4050 Dept. of Education, OSERS Dept. of Education, OSERS 10220 N. Executive Hills 401 South State St., Suite 700E Blvd. Chicago, IL 60605-1202 Kansas City, MO 64153- 1367 9-1-312-886-5372 Fax: 9-1-312-353-7341 9-1-816-891-8015 TDD: 9-1-312-353-9694 Fax: 9-1-816-374-6627 RSA BBS USER-ID: RSARCV TDD: 9-1-816-374-6917 -- Indiana RSA BBS USER-ID: RSARCVII -- Michigan -- Iowa -- Minnesota -- Kansas -- Ohio -- Nebraska -- Wisconsin -- Missouri -- Illinois Hours: 8:00 - 4:30 Hours: 8:15 - 4:45 EDST: 9:15 - 5:45 EDST: 9:15 - 5:45 REGION VI REGION VIII Mr. Loerance Deaver RSA Regional Commissioner RSA Regional Commissioner 06-5050 08-7050 Dept. of Ed., Dept. of Education, OSERS Federal Office Bldg. 1200 Main Tower Bldg., Rm. 2140 Suite 310 Dallas, TX 75202 1244 Speer Boulevard 9-1-214-767-2961 Denver, Co 80204-3582 Fax: 9-1-214-767-8127 9-1-303-844-6078 TDD: 9-1-214-767-8125 Fax: 9-1-303-844-6269 RSA BBS USER-ID: RSARCVI TDD: 9-1-303-844-2890 -- Arkansas RSA BBS USER-ID: RSARCVIII -- Louisiana -- Montana -- New Mexico -- N. Dakota -- Oklahoma -- S. Dakota -- Texas -- Utah -- Wyoming Hours: 8:00 - 4:30 -- Colorado EDST: 9:00 - 5:30 Hours: 7:30 - 4:00 EDST: 9:30 - 6:00 REGION IX REGION X Mr. Gilbert Williams RSA Regional Commissioner RSA Regional Commissioner 09-8050 10-9050 Dept. of Education, OSERS Dept. of Education, OSERS Federal Office Bldg., Room 215 915 Second Avenue, Room 50 United Nations Plaza 2848 San Francisco, CA 94102 Seattle, WA 98174-1099 9-1-415-556-7333 9-1-206-220-7840 Fax: 9-1-415-556-3634 Fax: 9-1-206-220-7840 TDD: 9-1-415-556-3323 TDD: 9-1-206-220-7849 RSA BBS USER-ID: RSARCIX RSA BBS USER-ID: RSARCX -- Arizona -- Alaska -- Hawaii -- Idaho -- Nevada -- Oregon -- Guam -- Washington -- American Samoa -- California Hours: 8:00 - 4:30 -- CNMI EDST: 11:00 - 7:30 -- Palau EDST: 11:00 - 7:30 Hours: 8:00 - 4:30 CENTRAL OFFICE DIRECTORY John Nelson Dr. Donald Thayer Branch Chief Program Specialist Independent Living Branch Independent Living Branch Special Projects Division Special Projects Division Office of Developmental Office of Developmental Programs, RSA Programs, RSA 330 C St., S.W., 330 C St., S.W., Room 3326 Room 3320 Washington, DC 20202-2741 Washington, DC 20202-2741 TEL: 202-205-9362 (V)(TDD) TEL: 202-205-9315 Fax: 202-205-9772 Fax: 202-205-9772 RSA BBS USER ID: JNELSON INTERNET: john nelson@ed.gov Hours: 8:00 - 4:30 Hours: 8:00 - 4:30 FORM 424 Form 424 is the standard application face page for Federal assistance (SF 424) and the concomitant instructions. Standard instructions for completing the SF 424 form immediately follow the form. Additionally, the supplemental instructions provided below are to be used in lieu of or along with the standard instructions for the following items: Item 1 - Preprinted Item 5 - Enter the name and telephone number of the CIL director (or principal contact). Item 6 - If the organization has been assigned a Department of Education (ED) entity number consisting of the IRS employer identification number prefixed by "1" and suffixed by a two-digit number, enter the full ED entity number in block 6. Item 8 - Preprinted. Item 10 - Preprinted. Item 12 - Insert the State and the geographical area which the center serves. UNITED STATES DEPARTMENT OF EDUCATION OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES REHABILITATION SERVICES ADMINISTRATION Washington, D.C. 20202-2741 FISCAL YEAR 19 ANNUAL PERFORMANCE REPORT FOR STATE INDEPENDENT LIVING SERVICES AND CENTERS FOR INDEPENDENT LIVING PROGRAMS PART II CENTERS FOR INDEPENDENT LIVING STATE NAME OF CENTER NAME OF GRANTEE GRANT # 7/7/95 THE REHABILITATION ACT OF 1973, AS AMENDED (ACT) APPLICATION FOR FEDERAL ASSISTANCE 2. Date Submitted Application Identifier N/A 1. TYPE OF SUBMISSION __ Construction X_ Non-Construction Preapplication N/A __ Construction __ Nonconstruction 3. DATE RECEIVED BY STATE State Application Identifier 4. DATE RECEIVED BY RSA Federal Identifier 5. APPLICANT [CENTER] INFORMATION Legal Name Organizational Unit Address (Give city, county, state, and zip code) Name and telephone number of the person to be contacted on matters involving this application (give area code) 6. Employer Identification Number ____ - ______________ 7. TYPE OF APPLICATION:(enter appropriate letter here) N A State F Intermunicipal K Indian tribe B County G Special District L Individual C Municipal H Indep. Schl Dist. M Profit Org. D Township I ST Cont. I of HL E Interstate J Private University N. Other: Private Non-Profit Organization 8. TYPE OF APPLICATION New X Continuation __ Revision If Revision, enter appropriate letter(s) here ___ ____ A Increase Award B Decrease Award C Increase Duration D Decrease Duration Other (specify) 9. NAME OF FEDERAL AGENCY: Dept. of Education 10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER 84.132A Title: Centers for Independent Living Program 11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT: 12. CENTER SERVICE AREA (cities, counties, states, etc.): 13. PROJECT: CENTER FOR INDEPENDENT LIVING 14. CONGRESSIONAL DISTRICTS OF: Start Date Ending Date a. Applicant b. Project 15. ESTIMATED FUNDING - Insert Amounts below only for next fiscal year. SEE 704 REPORT, SUBPART IIE 16. IS APPLICANT SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS? N/A a. YES THIS PREAPPLICATION WAS MADE AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON DATE _______ b. NO __ PROGRAM IS NOT COVERED BY E.O. 12372 __ OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW a. Federal $ .00 b. Applicant $ .00 c. State $ .00 d. Local $ .00 e. Other $ .00 f. Program Income $ .00 17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? ___ Yes If "Yes" attach an explanation ___ No g. TOTAL $ .00 18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS 704 REPORT, PART II ARE TRUE AND CORRECT. THE DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE CENTER AND THE APPLICANT WILL COMPLY WITH THE ORIGINAL APPLICATION ASSURANCES IF THE ASSISTANCE IS AWARDED. 19. a. Typed Name of Authorized Representative b. Title: c. phone/Fax #: d. Signature of Authorized Representative e. Date Signed Previous Editions Not Usable Standard Form 424 REV 4-88) Authorized for Local Reproduction Prescribed by OMB Circular A-102 INSTRUCTIONS FOR THE SF 424 This is a standard form used by applicants as a required facesheet for preapplications submitted for Federal assistance. It will be used by Federal agencies to obtain applicant certification that States which have established a review and comment procedure in response to Executive Order 12372 and have selected the program to be included in their process, have been given an opportunity to review the applicant's submission. Item: Entry 1. Self-explanatory. 2. Date application submitted to Federal agency (or State if applicable) & applicants control number (if applicable). 3. State use only (if applicable). 4. If this application is to continue or revise an existing award, enter present Federal identifier number. If for a new project, leave blank. 5. Legal name of applicant, name of primary organizational unit which will undertake the assistance activity, complete address of the applicant, and name and telephone number of the person to contact on matter related to this application. 6. Enter Employer Identification Number (EIN) as assigned by the Internal Revenue Service. 7. Enter "N. Other"- private non-profit" (Otherwise not eligible to apply). 8. Check appropriate box and enter appropriate letter(s) in the space(s) provided: - "New" means a new assistance award. - "Continuation" means an extension for an additional funding/budget period for a project with a projected completion date. - "Revision" means any change in the Federal Government's financial obligation or contingent liability from an existing obligation. 9. Name of Federal agency from which assistance is being requested with this application. 10. Use the Catalog of Federal Domestic Assistance number and title of the program under which assistance is requested. 11. Enter a brief descriptive title of the project, if more than one program is involved, you should append an Item: Entry: explanation on a separate sheet. If appropriate (e.g., construction or real property projects), attach a map showing project location. For preapplications use a separate sheet to provide a summary description of this project. 12. List the State and area (county, city, etc.) the applicant is applying to serve with this application. 13. Self-explanatory. 14. List the applicant's Congressional District and any District(s) affected by the program or project. 15. Amount requested or to be contributed during the first funding/budget period by each contributor. Value of in-kind contributions should be included on appropriate lines as applicable. If the action will result in a dollar change to an existing award, indicate only the amount of the change. For decreases, enclose the amounts in parentheses. If both basic and supplemental amounts are included, show breakdown on an attached sheet. For multiple program funding, use totals and show breakdown using same categories as item 15. 16. Applicants should contact the State Single Point of Contact (SPOC) for Federal Executive Order 12372 to determine whether the application is subject to the State intergovernmental review process. N/A 17. This question applies to the applicant organization, not the person who signs as the authorized representative. Categories of debt include delinquent audit disallowances, loans and taxes. 18. To be signed by the authorized representative of the applicant. A copy of the governing body's authorization for you to sign this application as official representative must be on file in the applicant's office. (Certain Federal agencies may require that this authorization be submitted as part of the application). SUBPART IIA: APPLICANT SELF EVALUATION (725(c)(8)(A) of the Act; 34 CFR 366.50(h)) I - COMPLIANCE INDICATOR 1 - PHILOSOPHY (725(b)(1) of the Act; 34 CFR 366.63(a)) (a) - Consumer control (725(b)(1)(A), 725(c)(2) and (6) of the Act; 34 CFR 366.63(a)(1)(A)) (1) Over 50 percent of the CIL's-- (I) Governing board is composed of individuals with significant disabilities. Yes No Number of (ii) CIL Employees Total Persons with Minority Positions Disabilities Employees (A) Decisionmaking positions (B) Staff positions (b) - Self-help and self-advocacy (725(b)(1)(B) of the Act; 34 CFR 366.63(a)(2)) The CIL during the reporting year has conducted activities that promote self-help and self-advocacy among individuals with significant disabilities Yes No (c) - Development of peer relationships and peer role models (725(b)(1)(C) of the Act; 34 CFR 377.73(a)(3)) The CIL during the reporting year has conducted activities that promote the development of peer relationships and peer role models among individuals with significant disabilities (e.g., activities using individuals with significant disabilities who have achieved IL goals [whether the goals were achieved independently or through assistance and services provided by a CIL] as instructors [volunteer or paid] in its training programs or as peer counselors). Yes No (d) - Equal access (725(b)(1)(D) of the Act; 34 CFR 377.73(a)(4)) The CIL-- (1) Ensures equal access, including communication and physical access, to the CIL's services, programs, activities, resources, and facilities, whether publicly or privately funded. Equal access, for purposes of this paragraph means that the same access is provided to an individual with a disability regardless of the individual's type of significant disability; Yes No (2) Advocates for and conducts activities that promote the equal access to all services, programs, activities, resources, and facilities in society, whether public or private, and regardless of funding source for individuals with significant disabilities. Equal access, for purposes of this paragraph, means that the same access provided to individuals without disabilities is provided in the center's service area to individuals with significant disabilities. Yes No (3) Makes available, as appropriate, all of its written policies, materials, and IL services in alternative formats . Yes No II - COMPLIANCE INDICATOR 2 - PROVISION OF SERVICES ON A CROSS- DISABILITY BASIS (725(b)(2) of the Act; 34 CFR 366.63(b)) The CIL-- (a) Provides IL services to eligible individuals or groups of individuals without restrictions based on the particular type or types of disabilities; Yes No (b) Provides IL services to individuals with a diversity of significant disabilities, and individuals who are members of populations that are unserved or underserved by programs under Title VII of the Act; and Yes No (c) Provides IL core services to individuals with significant disabilities in a manner that is neither targeted nor limited to a particular type of disability. Yes No III - COMPLIANCE INDICATOR 3--INDEPENDENT LIVING GOALS (725(b)(3) of the Act; 34 CFR 364.53, 366.63(c)) (a) The CIL maintains a CSR for each consumer that contains: (1) Documentation concerning eligibility or ineligibility for services; Yes No (2) Either an ILP or a waiver of the ILP Yes No (3) The IL goals or objectives established with the consumer Yes No (4) Records of the IL goals considered by the consumer to have been achieved; Yes No (b) The CIL maintains documentation: (1) That the CIL notifies all consumers of their right to develop or waive the development of an ILP; Yes No (2) On the number of ILPs developed by consumers receiving services from the CIL; Yes No (3) That the CIL facilitates the development and achievement of IL goals selected by individuals with significant disabilities who request assistance from the CIL; Yes No (4) That the CIL provides opportunities for consumers to express satisfaction with the CIL's services and policies in facilitating their achievement of IL goals and provides any results to its governing board and SILC; and Yes No (5) On the number of waivers signed by consumers receiving services from the CIL stating that an ILP is unnecessary Yes No IV - COMPLIANCE INDICATOR 4--COMMUNITY OPTIONS AND COMMUNITY CAPACITY (725(b)(4), 725(c)(10) of the Act; 34 CFR 366.63(d)) During the reporting year, the CIL promoted the increased availability and improved quality of community-based programs that serve individuals with significant disabilities and promoted the removal of any existing architectural, attitudinal, communication, environmental, or other type of barrier that prevents the full integration of these individuals into society. The CIL advocated for and performed at least one activity in each of the following categories: (a) Community advocacy; Yes No (b) Technical assistance to the community on making services, programs, activities, resources, and facilities in society accessible to individuals with significant disabilities; Yes No (c) Public information and education; Yes No (d) Aggressive outreach to consumers who are members of populations of individuals with significant disabilities that are unserved or underserved by programs under Title VII of the Act in the CIL's service area; and Yes No (e) Collaboration with service providers, other agencies, and organizations that could assist in improving the options available for individuals with significant disabilities to participate in the services, programs, activities, resources, and facilities in the service area. Yes No V - COMPLIANCE INDICATOR 5--IL CORE SERVICES AND OTHER IL SERVICES (725(b)(5) of the Act; 34 CFR 366.63(e)) The CIL-- (a) Provides information and referral services to all individuals who request these types of assistance or services from the CIL; and Yes No (b) As appropriate in response to their requests, provides to individuals with significant disabilities who are eligible for IL services from the CIL the following services-- (1) IL skills training; (2) Peer counseling (including cross- disability peer counseling); (3) Individual and systems advocacy; and (4) A combination, as appropriate, of any two or more other IL services. Yes No VI - COMPLIANCE INDICATOR 6--RESOURCE DEVELOPMENT ACTIVITIES ( 725(b)(6) of the Act; 34 CFR 366.63(f)) The CIL-- (a) Conducted resource development activities during the reporting year to obtain funding from sources other than Chapter 1 of Title VII of the Act. Yes No SUBPART IIB: NARRATIVE - COMPARISON OF THE ACTIVITIES OF THE CIL WITH THE REPORTING YEAR WORK PLAN AND WITH THE ACTIVITIES IN THE YEAR IMMEDIATELY PRECEDING THE REPORTING YEAR (725(c)(8)(F) of the Act; 34 CFR 366.50(I)(7)) ATTACHMENT II - B In the following order please provide: (a) A comparison of activities and accomplishments during the reporting year with the goals and activities included in the reporting year's work plan. Where appropriate, provide a brief comparison of program accomplishments and goal achievements during this reporting year with the immediately preceding reporting year . (b) If appropriate, descriptions of significant activities not accounted for elsewhere this report. (c) If appropriate, descriptions of substantial problems or difficulties, alternative solutions explored, and what worked (why?). SUBPART IIC: PROGRAM PLANNING OBJECTIVES (725(c)(4) of the Act; 34 CFR 366.50(d)) ATTACHMENT II - C(a): CIL WORK PLAN FOR NEXT FISCAL YEAR Attach a copy of next fiscal year's work plan. ATTACHMENT II - C(b): TRAINING AND TECHNICAL ASSISTANCE NEEDS (Section 721(b)(3) of the Act; 34 CFR 366.13) Please include this attachment on a separate page. In reviewing your work plans, please identify any areas in which you would like training and technical assistance. The Technical Assistance and Training Needs Assessments submitted as part of this report will be forwarded to the Training and Technical Assistance grantee funded under section 721 of the Act and to the Regional Continuing Education Program grantees for the purpose of establishing funding, training, and technical assistance priorities. SUBPART IID: SOURCES AND AMOUNTS OF RESOURCES FOR THE OPERATION OF THE CIL DURING THE REPORTING YEAR (725(c)(8)(D) of the Act; 34 CFR 366.50(I)(4)) I - Resources (a) Federal Funds 1. Ch. 1, part B, Title VII $ 2. Ch. 1, part C, Title VII $ 3. Ch. 2, Title VII $ 4. Other Federal Funds $ (b) Other Government Funds 5. State government funds $ 6. Local government funds $ (c) Private Funds 7. Foundation, corporation or trust grants $ 8. Donations from individuals $ 9. Memberships $ 10. Investment income, endowment $ 11. Fees for service (program income) $ 12. Other resources (in-kind items, etc.) $ (estimated fair value) (d) Total resources (Sum of lines 1--12) $ (e) Amount of total resources that "pass through" to consumers, e.g., personal assistant service funds $ (f) Net resources (line (d) minus line (e)) $ SUBPART IIE - NEXT FISCAL YEAR BUDGET INFORMATION Education Department Form No. 524 on the following pages is to be used for submittal of budget information for the forthcoming fiscal year, and for each remaining year of the grant. If a CIL has negotiated a budget for each year of its grant award, the CIL is not required to complete this section unless certain changes are anticipated in the budget for the next year. FORM NO. 524 U. S. DEPARTMENT OF EDUCATION BUDGET INFORMATION NON-CONSTRUCTION PROGRAMS OMB Control No. 1875-0102 Expiration Date: 9/30/95 Name of Institution/Organization: Applicants requesting funding for only one year should complete the column under "Project Year 1." Applicants requesting funding for multi-year grants should complete all applicable columns. Please read all instructions before completing form. SECTION A - BUDGET SUMMARY U.S. DEPARTMENT OF EDUCATION FUNDS Budget Categories Project Year 1 (a) Project Year 2 (b) Project Year 3 (c) Project Year 4 (d) Project Year 5 (e) Total (f) 1. Personnel 2. Fringe Benefits 3. Travel 4. Equipment 5. Supplies 6. Contractual 7. Construction N/A N/A N/A N/A N/A N/A 8. Other 9. Total Direct Costs (lines 1-8) 10. Indirect Costs 11. Training Stipends N/A N/A N/A N/A N/A N/A 12. Total Costs (lines 9-11) Name of Institution/Organization: Applicants requesting funding for only one year should complete the column under "Project Year 1." Applicants requesting funding for multi-year grants should complete all applicable columns. Please read all instructions before completing form. SECTION A - BUDGET SUMMARY NON-FEDERAL FUNDS Budget Categories Project Year 1 (a) Project Year 2 (b) Project Year 3 (c) Project Year 4 (d) Project Year 5 (e) Total (f) 1. Personnel 2. Fringe Benefits 3. Travel 4. Equipment 5. Supplies 6. Contractual 7. Construction N/A N/A N/A N/A N/A N/A 8. Other 9. Total Direct Costs (lines 1-8) 10. Indirect Costs 11. Training Stipends N/A N/A N/A N/A N/A N/A 12. Total Costs (lines 9-11) SECTION C - OTHER BUDGET INFORMATION (see instructions) SUBPART IIF NUMBERS AND TYPES OF INDIVIDUALS WITH SIGNIFICANT DISABILITIES RECEIVING SERVICES THROUGH THE CIL (13, 704(m)(4)(B), (D) of the Act; 34 CFR 364.50(I)(2)) I - Consumers Served during Year (a) CSRs carried from previous FY (b) CSRs started since Oct. 1 of report year (c) Total consumers served II - Consumers Inactive @ Sept. 30 (a) Moved (b) Withdrew (c) Died (d) Inactive because goals met (e) Other (f) Total III- Consumers (CSRs) Active @ Sept. 30 (I(c) minus II(f)) IV - Time Consumer (CSR) active (a) Less than 12 months (b) 12 months - 2 years (c) 2 years - 5 years (d) Over 5 years (e) Total V - Consumer Achievements (725(c)(14) of the Act; 34 CFR 364.43) (a) Number of individuals to whom an offer was made to develop an ILP but who waived the offer (b) Number of individuals with whom an ILP was developed during the year. Consumer Goals and Objectives Established and Achieved Objectives/Goals Total Goals set Total Goals met (a) Self-care (b) Communication (c) Mobility (d) Residential (e) Educational (f) Vocational (g) Other VI - Age (a) Under 6 (b) 6 - 17 (c) 18 - 22 (d) 23 - 54 (e) 55 & over VII - Gender (a) Female (b) Male VIII - Race/ethnicity (a) White (non-Hispanic) (b) Black (non-hispanic) (c) American Indian or Alaskan Native (includes Native Hawaiian) (d) Asian or Pacific Islander (e) Hispanic IX - Disability (a) Cognitive (b) Mental (c) Physical (d) Sensory (e) Multiple disability X - Living Arrangements CSR @ Sept. 30 (a) Institution (b) Dependent w/family or friends (c) Assisted living (c) Independent (d) Other XI - Source of Personal Assistance Services Reimbursement CSR @ Sept. 30 (a) Part B, Ch. 1, Title VII (b) Part C, Ch. 1, Title VII (c) Medicaid Waiver Program (d) Medicaid (e) Title XX (f) Other (g) None Available SUBPART IIG: TYPES OF SERVICES PROVIDED THROUGH THE CIL AND THE NUMBER OF INDIVIDUALS WITH SIGNIFICANT DISABILITIES RECEIVING EACH TYPE OF SERVICE (704(m)(4)(D), 725(c)(8)(C) of the Act; 34 CFR 364.43, 366.50(I)(3)) (Reporting the number of hours of Community Services performed is optional.) I - Community services Total Hours Conducted (Y/N) (a) Information and referral (b) Community and systems advocacy (c) Outreach (d) Publications (e) Community education (f) Maintaining registries (g) Other (h) Total (a - g) II - Individual services No. of Persons Served (a) Advocacy/legal services (b) Assistive devices/equipment (c) Children's services (d) Communication services (e) Counseling and related services (f) Family services (g) Housing and shelter services (h) Information and Referral (I) Independent living skills training and life skills training and services (j) Mental restoration (k) Mobility training (l) Peer counseling (including cross-disability peer counseling) (m) Personal assistance services, including attendant care and the training of personnel providing such services (n) Physical rehabilitation (o) Preventative services (p) Prostheses and other appliances (q) Recreational services (r) Rehabilitation technology (s) Therapeutic treatment (t) Transportation services (v) Youth services (w) Vocational services (x) Other 722 STATES: PROVIDE ONE COPY OF THIS REPORT TO YOUR SILC, ONE COPY TO THE RSA REGIONAL OFFICE, AND ONE COPY TO THE RSA CENTRAL OFFICE. IF THE CIL ALSO RECEIVES PART B FUNDS, PROVIDE ONE COPY TO THE DSU. IN 723 STATES: PROVIDE ONE COPY TO YOUR DSU, AND ONE COPY TO THE SILC. CILS FUNDED SOLELY WITH CHAPTER 1, PART B OF TITLE VII FUNDS OR STATE FUNDS: FILE THE REPORT WITH THE DSU. ALL REPORTS ARE DUE TO RSA NINETY DAYS AFTER THE END OF THE FISCAL YEAR FOR WHICH THE REPORT PERTAINS. I hereby affirm that the information contained in this 704 Annual Performance Report, Part II is true and correct to the best of my knowledge. SIGNATURE OF CIL DIRECTOR DATE SIGNATURE OF GRANT OFFICIAL DATE (if different from Director) NAME AND TITLE OF GRANT OFFICIAL PHONE NUMBER