IL NET an ILRU/NCIL National Training and Technical Assistance Project Expanding the Power of the Independent Living Movement HOW TO SURVIVE THE 704 REPORT A National Conference Participant's Manual April 15-16, 2002 Philadelphia, PA Contributors to the training materials: Paula Margeson Anne-Marie Hughey John Heveron Darrell Lynn Jones Kristy Langbehn Raweewan Buppapong Carri George Richard Petty Dawn Heinsohn (c) 2002 IL NET, an ILRU/NCIL Training and Technical Assistance Project ILRU Program NCIL 2323 S. Shepherd Street 1916 Wilson Boulevard Suite 1000 Suite 209 Houston, Texas 77019 Arlington, Virginia 22201 713-520-0232 (V) 703-525-3406 (V) 713-520-5136 (TTY) 703-525-4153 (TTY) 713-520-5785 (FAX) 703-525-3409 (FAX) ilru@ilru.org 1-877-525-3400 (V/TTY - toll free) http://www.ilru.org ncil@ncil.org http://www.ncil.org Permission is granted for duplication of any portion of this manual, providing that the following credit is given to the project: Developed as part of the IL NET: an ILRU/NCIL National Training and Technical Assistance Project. IL NET is funded through a special provisions cooperative agreement with the U.S. Department of Education, Rehabilitation Services Administration, Agreement No. H132B99002. How to Survive the 704 Report April 15-16, 2002 Philadelphia, PA Participant's Manual Table of Contents Agenda About the Trainers List of Trainers and IL NET Staff About ILRU About NCIL About IL NET Learning Objectives Data from 2000 704 Reports Writing Measurable Project Objectives Example of the "Logic Model" of program implementation developed by the United Way of America Continuous Process Improvement Using Performance Measures Organizational Analysis: Where is Your CIL Going? and Is It Getting There? Sample Completed 704 Report 704 Report Parts I & II Part I Part II ABOUT THE TRAINERS James Billy is the Independent Living Branch Chief at the Rehabilitation Services Administration in Washington, D.C. Prior to this appointment he held the position of executive director for nine years at the Harlem Center for Independent Living in Harlem, New York. He has served on advisory boards to The Rehabilitation Cultural Diversity Initiative, Region II (RCDI), World Institute on Disability and was a member of the New York Statewide Independent Living Council, New York State Rehabilitation Council, and the Disability Rights Action Coalition for Housing. Prior to his involvement in independent living, Mr. Billy was a special education teacher at the elementary school level, a clinician at the New York Institute of Child Development, Senior Counselor at Odyssey House Residential Treatment Center for Substance Abuse, and a Vocational Rehabilitation Counselor at Veratas Treatment Center. He has an M.Ed. in Rehabilitation Counseling from Hofstra University and a B.S. in Special Education from New York University. Anne-Marie Hughey is the Executive Director of the National Council on Independent Living (NCIL), a national membership organization which advocates for the rights of people with disabilities. Ms. Hughey has been in the field of independent living since the early 1980's. Since receiving her Masters Degree in Rehabilitation Counseling from State University of New York at Buffalo, she has been an active advocate for individuals with disabilities. Her first appointment was Executive Director of the newly funded Batavia Center for Independent Living. Ms. Hughey subsequently served as the Assistant Director of Resources for Living Independently in Philadelphia, PA. She provides training on the history and philosophy of the independent living and disability rights movement as well as speaks on a variety of disability and national advocacy issues to groups around the country. As a person with a disability, Ms. Hughey has been a life long advocate for disability and human rights. Ms. Hughey has always been very active in advocating for the development and implementation of laws and policies, which protect the rights of persons with disabilities on a local and national level. Paula Margeson has been involved in the independent living movement for 23 years, 11 of which she served as a CIL program director. As an individual who is totally blind and as a disability consultant, she has both a personal and professional interest in improving the quality of life for people with disabilities. She currently provides consulting services to a wide variety of public and private organizations, including Centers for Independent Living and Statewide Independent Living Councils. She has been preparing grant proposals and 704 Reports for CILs and SILCs since 1982. Ms. Margeson is the current chairperson of the Texas Statewide Independent Living Council. She has a bachelor's degree from California State University at Fullerton. How to Survive the 704 Report April 15-16, 2002 Philadelphia, PA TRAINERS James Billy Independent Living Branch Chief Rehabilitation Services Administration 330 C Street Room 3326 Washington, DC 20202 (202) 205-9362 (voice) (202) 260-9424 (Fax) James_Billy@ed.gov Anne-Marie Hughey Executive Director National Council on Independent Living 1916 Wilson Boulevard, Suite 209 Arlington, Virginia 22201 (877) 525-3400 (toll free) (703) 525-3406 (voice) (703) 525-3409 (Fax) (703) 525-4153 hughey@ncil.org Paula Margeson Disability Consultant 7928 Hook Drive Plano, Texas 75025 (972) 517-4435 (voice) (972) 517-6721 (fax) pmargeson@email.msn.com IL NET STAFF ILRU Lex Frieden Laurie Gerken Redd Executive Director Administrative Coordinator lfrieden@ilru.org lredd@ilru.org Richard Petty Carri George Program Director Publications Coordinator richard.petty@bcm.tmc.edu cgeorge@ilru.org Laurel Richards Dawn Heinsohn Training Director Materials Production Specialist lrichards@ilru.org heinsohn@ilru.org ILRU Program 2323 S. Shepherd Suite 1000 Houston, TX 77019 713-520-0232 (V) 713-520-5136 (TTY) 713-520-5785 (FAX) ilru@ilru.org http://www.ilru.org NCIL Anne-Marie Hughey Executive Director hughey@ncil.org NCIL 1916 Wilson Boulevard Suite 209 Arlington, VA 22201 703-525-3406 (V) 703-525-4153 (TTY) 703-525-3409 (FAX) 1-877-525-3400 (V/TTY - toll free) ncil@ncil.org http://www.ncil.org Kristy Langbehn Project Logistics Coordinator kristy@ncil.org Darrell Lynn Jones Training Specialist darrell@ncil.org Raweewan Buppapong Project Assistant toony@ncil.org 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. 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 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 THE IL NET This training program is sponsored by the IL NET, a collaborative project of the Independent Living Research Utilization (ILRU) of Houston and the National Council on Independent Living (NCIL). The IL NET is a national training and technical assistance project working to strengthen the independent living movement by supporting Centers for Independent Living (CILs) and Statewide Independent Living Councils (SILCs). IL NET activities include workshops, national teleconferences, technical assistance, on-line information, training materials, fact sheets, and other resource materials on operating, managing, and evaluating centers and SILCs. The mission of the IL NET is to assist in building strong and effective CILs and SILCs which are led and staffed by people who practice the independent living philosophy. The IL NET operates with these objectives: Assist CILs and SILCs in managing effective organizations by providing a continuum of information, training, and technical assistance. Assist CILs and SILCs to become strong community advocates/change agents by providing a continuum of information, training, and technical assistance. Assist CILs and SILCs to develop strong, consumer-responsive services by providing a continuum of information, training, and technical assistance. HOW TO SURVIVE THE 704 REPORT April 15-16, 2002 Philadelphia, PA Learning Objectives As a result of this training, participants will: 1. Understand what's in the Report and what it means. 2. Discover uses of the Report to support their organizational goals and resource development. 3. Identify ways the Report can facilitate consumer control. 4. Experience writing program objectives and outcome statements that give staff a meaningful work plan. 5. Hear how the Report is used to support legislative initiatives. 6. Learn how to assess their organization and programs and what impact they are really having on people's lives. DATA FROM 2000 704 REPORTS Number of Part C funded CILs 281* (*15 CILs Part C funded from 723 states.) Number of Part B & Part C Funded CILs 289 DATA ON PART B & C FUNDED CILs Total Resources* $315,137,780 (*The raw data shows 6 CILs missing their funding) Pass-through $120,710,812 Net Resources $194,426,968 Average Part C Funding level $162,565 Percentage of Total Resource Funds Title VII* 19% (* Includes Part B, Part C and Chapter 2) Other Federal 7% Other Government (state, local, etc) 48% Private Funds 7% Fee-for-Services 19% Consumers Served 141,149 Percentages in Age Groups < 6 2% 6 - 17 6% 18 - 22 7% 23 - 64 56% > 65 24% Unknown 4% Percentages in Gender Female 54% Male 45% Unknown 1% Percentages in Race American Indian/AK Native 2% Asian 3% Black 17% Hispanic/Latino 10% Native HI/Pacific Is 1% White 66% Unknown 1% Percentages in Disability Cognitive 11% Mental/Emotional 11% Physical 44% Hearing 7% Vision 6% Sensory 1% Multiple 17% Unknown 3% Consumer Achievements (Goals Met Top 4) Self-Care 26,243 Communication 15,008 Other* 13,564 (*Probably housing goals since the Housing (residential) Achievement is no longer an option) Self-Advocacy 11,041 Top six services requested by Consumers (not including I&R services) Personal Assistant Services 85,489 Skills Training 59,779 Advocacy 59,360 Peer Counseling 54,171 Housing/Home Modification 36,645 Transportation 36,162 Information & Referral Requests 480,591 Number of people relocated from a nursing home 1,467 Number of people able to remain in their community 18,980 Community Change Achievements (Goals Met Top 3) Barrier Removal 12,282 Housing Opportunities 3,322 Community Integration 2,588 Percentage in Community Services Community & Systems Advocacy 19% Outreach 12% Publications 7% Education 13% Registries 9% Collaboration/Networking 12% Other 28% Percentages of CIL Staffing Staff with disabilities 67% Staff from minority populations 25% DATA FROM 1998 704 REPORTS Number of Part B & Part C Funded CILs DATA ON PART B & C FUNDED CILs Total Resources* $315,137,780 (*The raw data shows 6 CILs missing their funding) Pass-through $120,710,812 Net Resources $194,426,968 Average Part C Funding level $162,565 Percentage of Total Resource Funds Title VII* 19% (*Includes Part B, Part C and Chapter 2) Other Federal 7% Other Government (state, local, etc) 48% Private Funds 7% Fee-for-Services 19% Consumers Served 141,149 Percentages in Age Groups < 6 2% 6 - 17 6% 18 - 22 7% 23 - 64 56% > 65 24% Unknown 4% Percentages in Gender Female 54% Male 45% Unknown 1% Percentages in Race American Indian/AK Native 2% Asian 3% Black 17% Hispanic/Latino 10% Native HI/Pacific Is 1% White 66% Unknown 1% Percentages in Disability Cognitive 11% Mental/Emotional 11% Physical 44% Hearing 7% Vision 6% Sensory 1% Multiple 17% Unknown 3% Consumer Achievements (Goals Met Top 4) Self-Care 26,243 Communication 15,008 Other* 13,564 (*Probably housing goals since the Housing (residential) Achievement is no longer an option) Self-Advocacy 11,041 Top six services requested by Consumers (not including I&R services) Personal Assistant Services 85,489 Skills Training 59,779 Advocacy 59,360 Peer Counseling 54,171 Housing/Home Modifications 36,645 Transportation 36,162 Information & Referral Requests 480,591 Number of people relocated from a nursing home 1,467 Number of people able to remain in their community 18,980 Community Change Achievements (Goals Met Top 3) Barrier Removal 12,282 Housing Opportunities 3,322 Community Integration 2,588 Percentage in Community Services Community & Systems Advocacy 19% Outreach 12% Publications 7% Education 13% Registries 9% Collaboration/Networking 12% Other 28% Percentages of CIL Staffing Staff with disabilities 67% Staff from minority populations 25% Writing Measurable Project Objectives Reprinted from Grant Writing Tools to Further Your Mission A National IL Net Training March 4-6, 2002 Participants Manual Writing Measurable Project Objectives One of the challenges faced by organizations trying to develop proposals in response to Federal announcements and requests relates to the problem of developing measurable objectives for the project. It's worth taking a quick look at the difference between goals, objectives, and activities. Resource Note: In discussing developing measurable objectives, we will refer to a 1999 publication produced by the Department of Education for its 21st Century Community Learning Centers Program. This publication, A Guide to Continuous Improvement Management (CIM), by Natalia Pane, Ivor Mulligan, Alan Ginsburg, and Andrew Lauland, can be downloaded from the Department of Education Website as an Acrobat file in pdf format.i It can be found at: http://www.ed.gov/offices/OUS/PES/21cent/cim226.pdf For those of you who need the document in an alternate format, the Adobe Acrobat Website provides a plug-in for Acrobat version 4.0 that allows you to export pdf files to text formats. You can obtain the 4.0 plug-in at the Adobe site by going to: http://www.adobe.com/support/downloads/5efe.htm If you download the Acrobat 5.0 reader from the Adobe site, it will have the access features built into it. Version 5.0 of the Acrobat reader is at: http://www.adobe.com/products/acrobat/readstep.html It is recommended that all disability-related service organizations obtain an accessible version of the Acrobat reader software so that you can provide accessible versions of documents published in pdf formats to your staff, consumers and others. Grant writers are also encouraged to retrieve the document A Guide to Continuous Improvement Management (CIM), and refer to it when preparing an application for the U.S. Department of Education. It offers excellent suggestions. A Guide to Continuous Improvement Management (CIM) differentiates goals and objectives as follows: * Goals reflect the program's broad intent by defining what is to be obtained through sustained effort over the long term. * Objectives specify what is to be achieved in a scheduled period of time in order to progress to each goal. For a project focusing on student achievement, you might state one or two broad goals, with clarifying points as part of each broad goal. The goal examples provided below were adapted from examples provided in A Guide to Continuous Improvement Management (CIM). Goal 1: To increase student academic performance and interest: a. By increasing performance in reading and mathematics. b. By increasing student motivation and interest in school. c. By increasing student development and applied academic experiences. d. By increasing student aspirations. Goal 2: To improve the learning environment: a. By providing a safe and nurturing environment. b. By providing a drug-free environment. c. By offering enrichment and learning opportunities outside of regular school curriculum. d. By reducing juvenile crime in the community. As these goal statements suggest, the goals should be broad enough to tell the reviewer where the project is going, while having enough specificity to provide a functional focus for the project. In these two goal statements one gets the clear sense that the project will target student performance and interest, while also addressing the environment in which learning will take place. Furthermore, from the points covered under the broad goal statements, it is easy to see that focus will be on reading and mathematics, student motivation and interest, applied academic experience, and student aspirations as regards the first broad goal. Also, the points made under the second broad goal make it clear that the project developers recognize the importance of the learning environment in fostering academic achievement, including providing a safe, drug-free environment that promotes learning beyond the classroom, while concurrently reducing juvenile crime in the community. These goal statements tell the reviewer a great deal about the factors that the project developers view as important in addressing issues of student achievement in a particular community setting. Where the goal statements are broad and point toward important issues to be addressed over the long term, objectives should be stated in measurable terms, specifying what is to be achieved in a scheduled period of time in order to progress toward goals.1 Objectives should:ii * Be definitive and specific; * Describe the accomplishments or results, not * activities or behaviors; * Be measurable (quantifiable); * Delineate a time frame or deadline; * Be challenging yet achievable; * Define your customers; and * Designate the partners and their responsibilities. Using the project on student achievement referred to under the goals and objectives above, let's take a look at some examples of good, better, and best stated objectives. These are excerpted from the A Guide to Continuous Improvement Management (CIM).1 They include a brief discussion of the gains realized in going from a good objective to a better stated objective, and on to further improvement in the "best" stated objective. Example 1 Good: Better: Best: Gains: Our primary objective is to maximize the number of children in the community who attend our program. Our program will provide at least 600 children in the community with educational, recreational, and enrichment activities over the next three years. Our program will provide at least one activity (educational, recreational, or enrichment) over the next three years to at least 600 different economically disadvantaged children in the community, and each child will participate in that activity for at least half the possible attendance days. What is the "maximum number of children" referred to in the first objective? The second objective provides a specific number that can be measured when assessing your program. In addition, the second example offers a timeline for when the objective is to be achieved. The third objective specifies who the 600 children will be and what counts as having participated in an activity (attending half the time). Example 2 Good: Better: Best: Gains: At the end of year three, our program will result in a decrease in crime in the community. After the third year of program operation, there will be a 15 percent reduction in the number of acts of vandalism in the community. After the third year of program operation, there will be a 15 percent reduction in the number of acts of vandalism on school grounds within the community compared to other schools in a neighboring and similar community. The second objective provides specifics about what kinds of crime: acts of vandalism. The third objective goes a step further in stating that the acts will be measured on school grounds, since these data are more likely to be accessible and more closely tied to students in the program. The third objective states that the rates will be compared to those of schools that do not have similar programs. If crime decreases in your town, but not in the other town, then the comparison provides a stronger argument that your program had something to do with the change. Conversely, if crime rates increase in your town, it may be because the whole state or area has experienced increasing crime. By comparing your community with another, you may be able to support a conclusion that your efforts had a favorable impact on crime rates because rates did not increase as much as those in similar communities. Example 3 Good: Better: Best: Gains: Student motivation will be improved and attendance at school will increase by 45 percent after the second year of the program. Motivation will be improved and attendance will improve by 10 percent after the first year and 20 percent by the second year of the program. Student and parent motivation will be improved (e.g., scores on a self-report survey will increase significantly) and student attendance at school and parent attendance at teacher conferences will improve by 10 percent after the first year of the program and 20 percent by the second year of the program. The first objective is definitely challenging, but may not be attainable after one year. The second objective sets a more attainable figure and sets two short-term targets instead of one longer-term target. The third objective specifies who is to be measured and for what activities. The Challenge of Writing Sound IL-Related Objectives The examples provided above work well within educational systems. However, it should be noted that: a) most educational systems have very easily quantified outcome measures; and b) well established data collection systems to draw upon for evaluation purposes. Among the problems faced by CILs and SILCs in trying to develop project-related objectives around independent living activities are: * A lack of research-based, quantifiable outcome measures for assessing the results of service delivery both on an individual and an organizational basis; * A dearth of data collection instruments and tools both for establishing baseline performance measures and for gathering the data needed to assess progress against the baseline; and * Few options for management information systems that allow IL personnel to generate needed outcomes information in an effective and efficient manner. This situation suggests that people working in IL need to be creative in developing measurable project objectives that target outcomes important to potential funding sources which have accountability requirements. During this workshop, we will explore ways of doing this, as well as resources that might be tapped in constructing measurable objectives for specific types of projects. Example of the "Logic Model" of program implementation developed by the United Way of America by Paula Margeson Example of the "Logic Model" of program implementation developed by the United Way of America Organization: The Empowerment Connection Program Title: Jobs Plus Goal: To increase the independence of persons with disabilities. Time Frame: Twelve months. The United Way logic model consists of six levels which include: ( inputs ( activities ( outputs ( initial outcomes ( intermediate outcomes ( long-term outcomes Inputs Staff: Program director, pre-employment trainer, job developer, service coordinator Program Settings: Organization's offices, satellite sites, career fairs, potential and actual work sites Service Technology: scheduling and reporting software, two accessible computer work stations, cell phone and laptop computer for field use Funding: Case service contract $200,000, United Way $30,000, Wordsworth Foundation $20,000 Participants: Persons with disabilities who wish to attain gainful employment. Consumer Characteristics: Adults eighteen years of age and older, representing a cross section of the disability population, primarily in the lower income range Activities Service Coordinator completes intake process, assists consumers to develop, implement, and monitor independent living plans, refers consumers to appropriate program components, maintains case files, and provides post-employment services such as recommendations for reasonable accommodation; Pre-employment Trainer provides individual and group instruction, describes various work incentives, assists with applications for extended benefits, and conducts job clubs; Job Developer Facilitates consumer involvement in job fairs, meets with employers and resource directors, researches job leads, participates in business associations such as Chambers of Commerce, and initiates cross referrals between employers and consumers; Program Director supervises staff, evaluates personnel and program performance, prepares progress reports, addresses problems in implementation, and oversees program costs; Outputs Seventy-five consumers complete intake process and develop independent living plans; Forty consumers participate in a minimum of twenty hours of pre-employment training; An average of fifteen consumers participates in weekly job club sessions; Fifty consumers attend at least one job fair; Working relations and cross referral systems are established with eighty employers; Sixty participants are provided with job referrals; Initial Outcomes Consumers participate in programs and access services on a daily, weekly and /or monthly basis; Participants in pre-employment services are more knowledgeable of effective job seeking techniques; Employers and resource directors are less apprehensive about interviewing and considering job applicants with disabilities; Consumers aggressively pursue appropriate job leads; Intermediate Outcomes Personal, social and environmental barriers to employment are reduced; Job seeking skills of participants are improved; Self-confidence of consumers is enhanced; Thirty participants obtain employment; Long Term Outcomes Seventy-five percent of those consumers attaining employment remain in their positions for at least one year; The socio-economic status and self-sufficiency of workers with disabilities improves consistently over time. Continuous Process Improvement Using Performance Measures From the Newsletter, "Profitable solutions for Nonprofits" Summer 2002 By John Heveron [Reprinted and adapted for CILs and SILCs with permission] Continuous Process Improvement Using Performance Measures From the Newsletter, "Profitable solutions for Nonprofits" Summer 2002 By John Heveron [Reprinted and adapted for CILs and SILCs with permission] Einstein said that "not everything that counts can be counted and not everything that can be counted counts". The objective of outcome measurement and monitoring is continuous improvement in the delivery of appropriate services. The efficiency of service delivery, satisfaction with services, stability and continued funding are all important and must be measured. Why should I measure? Outcome measurement is here to stay! The United Way of America has published a manual on the topic, many national organizations like the Girl Scouts of the USA, Big Brothers Big Sisters, the YMCA of the USA, Goodwill Industries and others have all been involved in outcome measurement and have provided resources to local agencies about outcome measurement. More importantly, funders are becoming increasingly aware of the value of outcome measurement. This ensures that to some extent, funding will be affected by outcome measurement. Outcome measurement focuses on the intended results of programs. Therefore, it provides useful information to continuously enhance programs to be sure that program objectives are being met. Outcome measurement demonstrates your desire for continuous improvement. This can translate to consumer satisfaction, staff motivation, volunteer support, and funder as well as community recognition. What should I measure? The answer is based on the objectives of the services you are providing. Measurements should be directed to outcomes--what a program accomplishes. The number of classes attended would normally be an output not an outcome. Skills acquired or employment that results from these classes would be an outcome. Measure the denominator. One thing we have learned about measuring results is that the wrong things are frequently measured. This is because the big picture of need is not always focused on. Most human service organizations are experts in the services they provide but not in the overall need of the population. Sufficient time and study must be devoted to analysis of the population and its needs to develop a proper analysis of how any agency's service fits into the big picture. Measuring results is much more meaningful in the context of the needs of the population. As an example, an organization may be very effective in providing services to people seeking accessible housing. However, the real problem may lie with a housing authority which is not fairly applying its Section 8 program. Armed with this knowledge, there may be greater focus on housing advocacy programs and also more emphasis on communicating to consumers how they can speak up against inequities. How often should I measure and for how long? Measuring and monitoring does not always have to be continuous but continuous improvement cannot happen without an ongoing measurement process. What specific kinds of things should be measured? Remember that the focus is on outcomes--not on outputs. Outcomes are about the mission. Outcomes are changes experienced by participants such as increased knowledge, skills or access to preferred choices, and by communities such as increased options for people with disabilities, improved accessibility and better informed public officials. Outcomes could include things like: Increased knowledge about negotiating accessible transportation Securing an accessible apartment Ability to reside in an independent setting Satisfaction by the consumer and/or the consumer's family Improved health through self-advocacy with medical professionals Changes in functional status, i.e. no longer in an institution Skills improved--employable, has interview skills, is working Improved self-confidence, working, seeking work Increase in the number of curb cuts within a municipality Increase in the number of accessible polling places Who is involved in the measurement process? The list above makes it clear that the measuring process can involve not only your consumers, but also their families, health providers, employers, teachers, public officials, and others. Also, measurement can occur during, shortly after, and well after services are delivered. The measurement process itself can include a follow-up survey of consumers and their families, or their teachers or supervisors, and various community leaders or officials. Focus groups can also be used. What standards are outcomes measured against? Benchmarks should be set for each measure. Be sure to select criteria that will show relationships between the services provided and the outcomes you are measuring. Usually you'll need to have a fair amount of experience with a particular program before you can develop appropriate measures. It is probably a good idea to develop possible outcome measures as you prepare a program budget and narrative. The insight you gain with actual program operations will help you determine whether those measures are available and appropriate. Also, experience with observing outcomes provides a standard to measure programs against. Are there legitimate concerns about outcome measurement? Unfortunately, the wrong things do get measured frequently out of confusion or because certain criteria are not easy to measure. In other cases, results with consumers with complex needs which are served over a long period of time can be misinterpreted as poor outcomes. Also, communities unwilling to comply with access laws and codes may confuse the real effectiveness of efforts. What other tools and resources are available for outcome measurement? The United Way of America Manual Measuring Program Outcomes: a Practical Approach is a great starting point. Also, check with your state or national affiliate to determine whether they have resources available. There is some software available for outcome measurement. Some examples include N Works 2000 designed by the Neighborhood Reinvestment Corporation; Case Manager, a database developed for social services, and IPASS Outcomemetrics, which was designed for Health and Human Services agencies. Clearly, outcome measurement is challenging. But it can help with service delivery, and it is likely to be required or expected by funders and others. ORGANIZATIONAL ANALYSIS: WHERE IS YOUR CIL GOING? and IS IT GETTING THERE? (c) 1994 by Maggie Shreve, Organization Development Consultant Below are brief statements to be completed by you about your CIL. Definitions for key terms precede each statement. 1. VISION * something seen in a dream; * an object of imagination; * the art or power of imagination; * mode of seeing or conceiving; * unusual discernment or insight As a result of our CIL's vision and work, I see a community where: 2. MISSION * a body of persons sent to perform a service or carry on an activity Our CIL's purpose within this vision is to: 3. GOALS * the end toward which effort is directed (aim) OBJECTIVES * something toward which effort is directed (goal, aim) To fulfill our purpose and to realize our vision, our CIL has the following long-term goals objectives (permanent goals or goals which will take 3 or more years to accomplish): 1. _____________________________________________ ___________________________________________________ 2. _____________________________________________ ___________________________________________________ 3. _____________________________________________ _____________________________________________ 4. _____________________________________________ _____________________________________________ 5. _____________________________________________ _____________________________________________ 6. _____________________________________________ _____________________________________________ 7. _____________________________________________ _____________________________________________ 8. _____________________________________________ _____________________________________________ 4. ACTION * the manner or method of performing; * a thing or things done; * behavior, conduct; * often implies more than one step, is continuous is capable of repetition To reach our long-term goals/objectives, our center engages in the following actions on a regular basis (activities done daily, weekly, or monthly): 1) _______________________________________________ 2) _______________________________________________ 3) _______________________________________________ 4) _______________________________________________ 5) _______________________________________________ 6) _______________________________________________ 7) _______________________________________________ 8) _______________________________________________ 9) _______________________________________________ 10) _______________________________________________ 11) _______________________________________________ 12) _______________________________________________ 13) _______________________________________________ 14) _______________________________________________ 15) _______________________________________________ 5. STRATEGY * the science and art of employing the political, economic, psychological and military forces of a nation or group to afford maximum support to adopted policies in peace or war STRATEGIC * necessary to or important in the initiation, conduct or completion of a strategic plan Our center uses different strategies (methods or approaches) to conduct our activities and to reach our goals/objectives. Some of our strategies are: 6. POLICY * prudence or wisdom in the management of affairs; * management or procedure based primarily on material interest; * a definite course or method of action selected from among alternatives and in light of given conditions to guide and determine present and future decisions. Our center has developed policies to guide staff and volunteers in completing their work so that our vision, mission and goals will be realized over time. Samples of some of these policies include: 7. PROCEDURE * a particular way of accomplishing something or of acting; * a step in a procedure; * a series of steps followed in a regular definite order Certain procedures have been established within our center to ensure that we follow policies in reaching our goals, fulfilling our mission and realizing our vision. Examples of some procedures which facilitate goal accomplishment by our center include: 8. EVALUATION * the determination or fixation of a value * the determination of the significance, worth or condition of something, usually by careful appraisal and study To assess how well our center is doing in realizing our vision and fulfilling our mission, we should evaluate progress on our long-term goals/objectives. Here is how we should or do evaluate ourselves on each of the goals listed in number 3. GOAL HOW EVALUATED 1) 2) 3) 4) 5) 6) 7) SELF-ANALYSIS: Where Do I Fit Into the Organizational Analysis? Name: Title: 1. I report to: (Title of your immediate supervisor or supervisors) 2. ...who reports to: (Title of your supervisor's supervisor or supervisors) 3. My responsibilities for program evaluation include (list all that apply): 4. I am expected to produce the following reports (list all that apply): 5. My authority over or for program evaluation could be described as: 6. We face a number of pressures for reporting which have a direct impact on our program evaluation methods. These sources and the pressures they apply include: Source of Pressure Evaluation Pressures Applied 7. The problems I see with program evaluation in our center include: 8. The most important information we could possibly get form a superior program evaluation system would be (list 3 to 5 things, in priority order, you think are critical to knowing how effective your center is in relationship to your vision and mission.): 1) 2) 3) 4) 5) 9. We could do a better job of program evaluation if (complete the sentence with as many points as you can): *__________________________________________________ *__________________________________________________ *__________________________________________________ *__________________________________________________ *__________________________________________________ 10. My personal values related to program evaluation include (list the things you value from a program evaluation system, whether the data is relevant or not relevant to your vision, mission, or funding source requirements): *_________________________________________________ *__________________________________________________ *__________________________________________________ Sample Completed 704 Report By Paula Margeson REPORTING INSTRUMENT OMB Control Number: 1820-0606 Expiration Date: November 30, 2003 United States Department Of Education Office of Special Education and Rehabilitation Services Rehabilitation Services Administration PART II The Centers for Independent Living Programs Chapter 1, Title VII of the Rehabilitation Act, as Amended Fiscal Year 2000 With Citations Grant # H1 33060095 Name of Center: Empowerment Connection Acronym for Center (if applicable): None STATE: CALIFORNIA Counties Served: Smith County Subpart IIA - Administrative Data Subpart IIAI - Sources and Amounts of Funds and Resources (A) Federal Funds (1) Ch. 1, Part B, Title VII $______________ (2) Ch. 1, Part C, Title VII $____231,581___ (3) Ch. 2, Title VII $______________ (4) Other Federal Funds $____843,924____ (B) Other Government Funds (5) State Government Funds* $____298,411___ (6) Local Government Funds* $______________ (C) Private Resources (7) Foundations, Corporation, or Trust Grants $___137,075____ (8) Donations from Individuals $______________ (9) Membership Fees $______________ (10) Investment Income/Endowment $_____5,802_____ (11) Fees for Service (program income, etc.) $___289,518_____ (12) Other resources (in-kind, fund raising, etc.) $____93,382___ (D) Total Resources (sum of lines 1-12) $__1,899,693____ (E) Amount of total resources that "pass through" to Consumers, e.g., personal assistance services fund $____________ (F) Net Operating Resources (D) - (E) = (F) $__1,899,693____ * Include "pass through" funds. Subpart IIB - Numbers and types of individuals with significant disabilities reciving services either directly from the CIL (Section 13, 704(m)(B) and (D); 34 CFR 364.53) Subpart IIBI - Consumers Served During the Reporting Year (A) CSRs carried from previous year ___1,100__ (B) CSRs started since Oct. 1 of the reporting year ____330___ (C) Total consumers served: (A) + (B) =(C) ___1,430___ Subpart IIBII - Consumer CSRs Closed by September 30 of the Reporting Year (A) Moved ___119____ (B) Withdrew _____4____ (C) Died _____1____ (D) Completed all goals set ____10____ (E) Other ____22____ (F) Total Closed CSRs: (A) + (B) + (C) + (D) + (E) = (F) ___156____ Subpart IIBIII - Consumer CSRs Active on September 30 of the Reporting Year Subpart IBI (C)-Subpart IBII (F) = Subpart IBIII __1,274____ Subpart IIBIV - Consumer Plans and Waivers (A) Number of individuals who signed a waiver ____0_____ (B) Number of individuals with whom an ILP was developed __274_____ Subpart IIBV - Age (A) Under 6 _____64_____ (B) 6 - 17 _____38_____ (C) 18 - 22 _____51_____ (D) 23 - 64 _____727____ (E) 65 & Over _____353____ (F) Unknown ______39____ Subpart IIBVI - Gender (A) Female _____700___ (B) Male _____592___ Subpart IIBVII - Ethnicity (Select one) (A) Hispanic or Latino _____286___ (B) Not Hispanic or Latino ____1,144___ Subpart IIBVIII - Race (Choose one or more) (A) American Indian or Alaska Native _____43_____ (B) Asian ____215_____ (C) Black or African American ____100_____ (D) Hispanic or Latino ____286_____ (E) Native Hawaiian or Other Pacific Islander ______0_____ (F) White ___1,430____ Subpart IIBIX - Disability (A) Cognitive ____100____ (B) Mental/Emotional ____200____ (C) Physical ____729____ (D) Hearing ____100____ (E) Vision ____100____ (F) Multiple Disability ____200____ (G) Other ______0____ Subpart IIC - Individual and Community Achievements and Services Subpart IICI - Individual Consumer Achievements Goals Set Goals Met (A) Self-Advocacy/Self-Empowerment ____79____ _____31___ (B) Communication ____90____ _____87___ (C) Mobility/Transportation ____30____ _____11___ (D) Community Services _____0____ ______0___ (E) Educational ____13____ ______3___ (F) Vocational ____11____ ______1___ (G) Self-Care ____15____ _____15___ (H) Information Access/Technology ____28____ _____16___ (I) Personal Resource Management _____0____ ______0___ (J) Other _____46___ _____34___ Subpart IICII - Individual Services (A) Advocacy/Legal Services ___134____ (B) Assistive Devices/Equipment Services ___124____ (C) Children's Services ___102____ (D) Communication Services ___248____ (E) Counseling and Related Services _____0____ (F) Family Services ____75____ (G) Housing, Home Modifications, and Shelter Services ___326____ (H) IL Skills Training and Life Skills Training Services ____97____ (I) Information and Referral Services __1457____ (J) Mental Restoration Services _____0____ (K) Mobility Training Services ____52____ (L) Peer Counseling Services ___175____ (M) Personal Assistance Services ___215____ (N) Physical Restoration Services _____0____ (O) Preventive Services _____0____ (P) Prostheses and Other Appliances _____0____ (Q) Recreational Services _____0____ (R) Rehabilitation Technology Services _____0____ (S) Therapeutic Treatment _____0____ (T) Transportation Services ____52____ (U) Youth Services _____9____ (V) Vocational Services _____0____ (W) Other Services _____0____ Subpart IICIII - Individual Consumers in Community Based-Living (A) How many individuals were successfully relocated from nursing homes or other institutions to community-based living arrangements? ______0____ (B) See Instructions - How many individuals for whom IL services prevented the necessity of entering nursing homes or other institutions and therefore continued living in community-based living arrangement? _____0____ Subpart IICIV - Community Change Achievements Goals Set Goals Met (A) Community Integration ____11____ _____0____ (B) Collaboration ____22____ _____5____ (C) Educational _____0____ _____0____ (D) Housing Opportunities/ Home Modification ____17____ _____2____ (E) Information Access/Technology ____17____ _____4____ (F) Mobility/Transportation ____17____ _____2____ (G) Personal Assistant Services ____11____ _____1____ (H) Physical/Attitudinal Barrier Removal ____22____ _____5____ (I) Vocational _____0____ _____0____ (J) Other _____0____ _____0____ Subpart IICV - Community Services (A) Community and Systems Advocacy _____672__ (B) Outreach Efforts _____961__ (C) Publications ______89__ (D) Community Education/Integration Services _____437__ (E) Maintaining Registries/Libraries/Databases _____114__ (F) Collaboration/Networking _____310__ (G) Other Services ____8490__ (H) Grand Total Hours [Add (A) through (G)] ___11072__ Subpart IID - CIL Self-Evaluation based on the Six Compliance Indicators Subpart IIDI - Compliance Indicator 1: Philosophy (A) Consumer Control (1) Please complete the chart below CIL Employees Total Positions Number of Persons with Disabilities Number of Persons who are Minorities Decision Making Positions 5 4 1 Staff Positions 37 22 17 (2) Over 50 percent of the CIL's Governing Board is composed of individuals with significant disabilities __X__ YES _______NO (B) Self-Help and Self-Advocacy During the reporting year the CIL has conducted activities that promote self-help and self-advocacy among individuals with significance disabilities. __X____ YES _______NO (C) Development of Peer Relationships and Peer Role Models During the reporting year the CIL has conducted activities that promote the development of peer relationships and peer role models among individuals with significant disabilities as instructors and counselors in its programs. __X____ YES _______NO (D) Equal Access (1) Ensures equal access to the CIL's services, programs, activities, resources, and facilities, whether publicly or privately funded. Equal access means that the same access is provided to the individual with a disability regardless of the individual's type of disability. __X____ YES _______NO (2) The CIL advocates for and conducts activities that promote equal access to all services, programs, activities, resources, and facilities in society, whether public or private, and regardless of funding sources for individuals with significant disabilities. Equal access means that the same access provided to individuals without disabilities is provided in the center's service area to individuals with significant disabilities. __X____ YES _______NO (3) The CIL makes available, as appropriate, all written policies, materials, and IL services in alternative formats. __X____ YES _______NO Subpart IIDII - Compliance Indicator 2: Provision of Services on a Cross-Disability Basis The Center provides the following: (A) IL services to eligible individuals or groups of individuals without restrictions based on the particular types of disabilities that the individuals or groups of individuals may have. __X____ YES _______NO (B) 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. __X____ YES _______NO (C) IL core services to individuals with significant disabilities in a manner that is neither targeted nor limited to a particular type of disability. __X____ YES _______NO Subpart IIDIII - Compliance Indicator 3: Independent Living Goals (A) The CIL maintains a CSR for each consumer that contains: (1) Documentation concerning eligibility or ineligibility of services __X____ YES _______NO (2) Either an ILP or a waiver of the ILP ___X____ YES _______NO (3) IL goals or objectives established with the consumer ____X__ YES _______NO (B) The CIL maintains documentation indicating: (1) The CIL notifies all consumers of their right to develop or waive the development of the ILP ____X__ YES _______NO (2) The number of ILPs developed by consumers receiving services from the CIL ____X__ YES _______NO (3) The CIL facilitates the development and achievement of IL goals selected by individuals with significant disabilities who request assistance from the CIL ____X__ YES _______NO (4) 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 the SILC ____X__ YES _______NO (5) The number of waivers signed by consumers receiving services from the CIL stating that an ILP is unnecessary ____X__ YES _______NO Subpart IIDIV - Compliance Indicator 4: Community Options and Community Capacity (A) During the reporting year, the CIL promoted: (1) Increased availability and improved quality of community-based programs that serve individuals with significant disabilities ____X___ YES _______NO (2) Removal of any existing architectural, attitudinal, communication, environmental, or other type of barrier that prevents the full integration of individuals with significant disabilities into society ____X__ YES _______NO (B) During the reporting year, the CIL performed at least one activity in each of the following categories: (1) Community Advocacy ____X__ YES _______NO (2) Technical assistance to the community on making services, programs, activities, resources, and facilities in society accessible to individuals with significant disabilities ____X__ YES _______NO (3) Public Information and Education ____X__ YES _______NO (4) 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 services area ____X__ YES _______NO (5) 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 services area ____X__ YES _______NO Subpart IIDV - Compliance Indicator 5: IL Core Services and Other IL Services (A) The CIL provides Information and Referral (I & R) services to all individuals who request this type of assistance or service from the center, in formats accessible to the individual requesting these services ____X__ YES _______NO (B) As appropriate in response to requests, the CIL provides to individuals with significant disabilities who are eligible for IL services from the CIL the following services: (1) IL Skills Training ____X__ YES _______NO (2) Peer Counseling Services (including cross-disability peer counseling) ____X__ YES _______NO (3) Individual and Systems Advocacy ____X__ YES _______NO (4) As appropriate, two or more of the IL services defined in Title VII, section 7(18) of the Act ____X__ YES _______NO Subpart IIDVI - Compliance Indicator 6: Resource Development Activities The CIL conducts resource development activities to obtain funding from sources other than Chapter 1 of Title VII of the Act ____X__ YES _______NO Subpart IIE - Comparison of Program Activities with the reporting year work plan and with the planned activities in the year immediately preceding the reporting year The Empowerment Connection is a duly authorized Independent Living Center. It is the mission of the organization to advance the empowerment and inclusion of all people with disabilities. The center upholds the principles of consumer control, peer support, self-help and self-determination, equality, and positive systemic change. The service area of the Empowerment Connection is Smith County, California, an approximate 800 square-mile region with an estimated disability population of 450,000 residents. In the 2000/2001 fiscal year, the organization received two Title VII C grants, one to support the provision of core independent living services through the center's main offices and the other to operate a branch office in the southern region of the service area. This report will address the progress attained through the primary funding allocation and summarize the activities conducted during the grant period, compare actual accomplishments to planned objectives, analyze this year's performance in relation to that of the prior year, and provide evidence of compliance with standards and indicators set forth for the operation of independent living centers in Title VII of the Rehabilitation Act, as amended. A concurrent report is being submitted to review progress achieved through the secondary Title VII C grant. (A) ADVOCACY EFFORTS COMMUNITY ACTIONS The Empowerment Connection engages in community advocacy to bring about positive systemic change and to increase options for independent living. Specific activities defined to facilitate progress in this regard during the 2000/2001 program year were: * Implementation of strategies defined in the long-range plan to promote more accessible transportation and housing within Smith County; * Participation in twelve administrative or advisory bodies that have the capacity to facilitate system changes; * Provision of testimony at public forums or hearings in an attempt to improve the quality of life for individuals who are disabled; * Submission of input regarding the formulation and implementation of public policies and programs; * Advancement of self-advocacy opportunities among consumers; * Completion of 520 hours in systems advocacy activities. As per the center's current long-range plan, systems advocacy efforts focused on issues related to housing and transportation. Strategies employed in the grant period to impact these concerns included a presentation before the county's Special Needs Housing meeting to advocate for programs to increase accessibility of rental units in the region; provision of testimony before the planning commission of a local city on behalf of a proposed new affordable apartment building; participation in the Public Restructuring Bus Task-force; and consultation with the local paratransit provider regarding the revision of administrative policies to improve services and the development of a fully accessible Riders Guide. At the present time, center representatives serve on thirteen commissions or advisory committees, which have the capacity to facilitate system changes. Among these are the Area Agency on Aging Senior Citizens Advisory Council, the Smith County Long Term Care Coalition, Immigrant Rights Alliance, the Low-Income Housing Coalition, the Health Consumer Action Advisory Council, the Partnership for Responsible Public Policy coalition, the Human Affairs Forum, and the Adults for Youth Coalition. Several opportunities to offer testimony at public hearings were available during the grant period. Examples of these incidents included a statement before the Work-force Investment Board regarding the need for increased inter-agency collaboration to enhance the employment of persons with disabilities and provision of evidence before the County of Smith Community Development Commission concerning the plight of homeless people with significant disabilities. Input regarding existing or proposed public policies and programs was submitted by letter and telephone on numerous occasions to elected officials and agency administrators. In one such instance, contact was made with all congressional leaders regarding the "Real Choice Systems Change Grants" urging appropriation of $250 million to assist states in implementing the Olmstead decision and ending the current institutional bias. Additionally, Congressperson Susan Austin and her assistant, Ray Billings, visited the center and requested staff input on key issues related to disability. Consumers have been urged to initiate systemic advocacy strategies in general and under specific circumstances. With this aim in mind, four individuals attended the Southern California Disability Rights Leadership Conference at Loyola Law School to learn about various methods of facilitating systemic change. One client, who had encountered inaccessibility at a local motel, was advised by center staff regarding effective tactics to address this issue. The Empowerment Connection was also instrumental in facilitating consumer participation in a project allowing paratransit and public transportation users with disabilities to monitor and assess current services. At the conclusion of the program year, 781 hours in systems advocacy had been documented. Overall, the projected activities were implemented and performance levels were slightly higher than those achieved in the prior grant period. These activities are evidence of the center's compliance with Indicators 725(b)(1)(B) and 725(b)(4)(a) of the Act. TECHNICAL ASSISTANCE Technical assistance is offered by the Empowerment Connection to the community with the intent of sharing expertise gain by the organization. and promoting voluntary compliance with disability policies and regulations. Proposed activities for the 2000/2001 grant period were: * Provision of professional advice and support two eight agencies that serve persons with disabilities; * Presentation of information and assistance through the World Wide Web; * Coordination of four workshops to consumers regarding topics related to independent living; * Provision of technical consultation and disability training on twenty separate occasions. Technical assistance was provided to several organizations to enhance services to people, who are disabled. Examples of this involvement included: participation in a "Employment Focus Group" for the U.S. Department of Health & Human Services, as part of a national research study on the supportive services used by workers with disabilities and assessment of a Medicare-authorized health provider, Life Care Solutions, to insure compliance with ADA and other civil rights regulations. Thirty visitors from the Able-1 program attended a Service Providers' Meeting to learn how each of the center's service components operates. The most intense assistance was provided to a grass-roots organization in central Williamson County, which applied to become the independent living center for that region. State and federal funding was granted to this group with the provision that the Empowerment Connection continues to provide administrative support during the formative period. The agency met its goal to establish a web site on the Internet. The web address is: http://www.empowermentconnectioncenter.org. In addition to describing the agency's programs, the site introduces staff members, presents articles on independent living, and allows visitors to correspond with the organization. Email addresses were also established for all of the Center's key employees. Consumer training was conducted on numerous occasions. Some topics covered were: assistive technology, library services for persons with specific disabilities, the history and philosophy of the independent living movement, and effective communication and methods of navigating the In-Home Supportive Services system. In-service training was provided to select audiences on sixteen occasions. Some of These sessions were: a presentation to the Urban Unified School District Special Education Advisory Board regarding the role of centers in transitional planning for youth with disabilities; consultation to Smith County Human Relations Commission concerning the effects of disability in various cultures; and special testimony before the unemployment appeals board. For the most part, activity levels exceeded projections and were higher than accomplishments reported in the prior program year. This data demonstrates the agency's compliance with Indicator 725(b)(4)(b) of the Act. COLLABORATION The Empowerment Connection works with other public and private organizations in an effort to advance a broad continuum of services for consumers and to eliminate fragmented or duplicative assistance. Planned activities to promote collaboration in the 2000/2001 program year were: * Initiation of cross referrals with both public and private agencies in Smith County; * Participation in fifteen agency coalitions or service networks; * Maintenance of membership in four business associations to broaden the agency's spear of influence within the community; * Provision of contracted services for sixty agencies and/or businesses; * Participation in at least two collaborative projects for which special funding has been obtained; * Maintenance of ten satellite sites through the donation of office space at other community-based programs. For some years, the center has engaged in a cross-referral system with a variety of public and private agencies. Among these are the Department of Vocational Rehabilitation, Team of Advocates for Special Kids, the Regional Center, the Fair Housing Council, the Social Security Administration, the Smith Caregivers Association, In-Home Supportive Services, and the Braille Institute. Center representatives participated in eighteen service networks and/or coalitions during the reporting period for the purpose of gaining from the ideas and experiences of other organizations. Some of these groups were: the Smith County Long-term Care Coalition, the Irvine Valley College Disabled students Advisory Committee, the Smith County Transportation District citizens Advisory Council, the Human Affairs Forum, the Adults for Youth Coalition, and several one-stop centers. Membership was established in area chambers of commerce including the Latino Businessmen's Association. The agency's director is a member of the State Independent Living Council, the body that has primary responsibility for planning and monitoring the provision of independent living services in California. The Empowerment Connection also maintained active membership in both the National Council of Independent Living Centers and in the California Foundation of Independent Living Centers. Collaboration was exhibited by the center in the grant period through the sharing of facility space and resources. The organization provided office space for Protection and Advocacy Inc while maintaining satellite sites at more than a dozen agencies throughout Smith County. Some of these host locations were the Belle Community Center, Human Options, San Marcos Outreach and AIDS Foundation, the South Coastal One-Stop Center, and the Angeltown Work Center. Contracted services were provided by the center for approximately seventy public and private entities throughout Smith County. The majority of these were area businesses and hospitals, which contracted with the organization for the provision of sign language interpretation. During the reporting period, the Empowerment Connection continued to be a part of a coordinated effort by the county to assure a continuum of care for persons, who are homeless. As a part of this collaborative, the center provided a comprehensive support system for the purpose of promoting stability among persons with disabilities as they transition from emergency shelter to community life. This project was funded through a Super NoFa issued by HUD. A collaborative proposal was also submitted to provide art and recreation opportunities for children and youth with disabilities. The proposed alliance was between the Empowerment Connection, Stop-Gap Drama Therapy Troup, and the center for the arts and music. While a grant was not obtained, the collaborative will continue to pursue funding in the coming year. An agreement was also formed with Chapman University through its community clinic to obtain student interns for the purpose of facilitating client support groups. This approach will be a benefit to both the center and the college since staff will be augmented and students will gain practical experience working with consumers. The level of collaboration accomplished by the Empowerment Connection during the 2000/2001 program year was at or above projections and somewhat higher than in the previous grant period. These activities are reflective of the center's compliance with Indicator 725(b)(4)(e) of the Act. EDUCATION CAMPAIGNS Public education is conducted by the Empowerment Connection in order to heighten awareness concerning disability-related issues. The proposed activities for the reporting period were: * Completion of sixty public education presentations; * Participation in fifty educational events; * Provision of 300 hours of community education activities; * Production and circulation of an agency newsletter and informative materials resulting in the provision of 1,500 publication-related hours; * Coordination of "Independent Living Day" throughout Smith County. Center representatives reported conducting seventy-one presentations during the program year. Audiences included elementary and secondary schools, service clubs, area businesses, and consumer groups. Various staff and volunteers participated in forty-two educational events such as information exchanges, agency fairs, and expositions. A particularly innovative educational project in which the Empowerment Connection participated was "TouchStone Goals." Sponsored by an area organization that provides a variety of services to disadvantaged youth in Smith County, the intent of the project was increase disability awareness. Center staff made presentations to 10 groups with participants varying from kindergartners to high school students. The presenters shared how they have adapted to their disabilities and achieved independence. Fifteen of the students came to volunteer at the center and assisted with wrapping toys and assembling baskets for the holiday gift program. The organizational newsletter was not published during the program year. This was due to a prolonged vacancy in the community relations position. Because this staff person is responsible for the development and dissemination of publications, actual service hours completed were 103, only seven percent of the projected amount and ten percent lower than in the prior year. Without a community relations director it was also not possible to plan and conduct "Independent Living Day" throughout the county. During the reporting period, 508 hours of public education activities were recorded. With the exception of the latter two activities, performance was near or above projections and significantly exceeded that reported in the 1999/2000 program year. This information is evidence of the center's compliance with Indicator 725(b)(4)(c) of the Act. LEGAL ACTIONS Should the Empowerment Connection determine that a situation requires the pursuit of legal action to ensure the rights of persons with disabilities, the agency would present the matter to the governing board and follow the directive of that body. No such action was taken during the reporting period, nor were activities projected in this regard. (B) OUTREACH EFFORTS Any resident of Smith County is eligible for assistance through the Empowerment Connection, regardless of age, ethnicity, gender, or type or origin of disability. Of those individuals assisted during the 2000/2001 fiscal year, eight percent were seventeen years of age or younger, four percent were between the ages of eighteen and twenty-two, fifty-seven percent were between the ages of twenty-three and fifty-four, twenty-eight percent were fifty-five years of age or older, and three percent failed to provide this information. Forty-five percent of the consumers were male and fifty-five percent were female. Fifty-five percent of those served were Caucasian, seven percent were black or African American, three percent were native Alaskans or American Indians, fifteen percent were of Asian origin, and twenty percent were Latino or Hispanic. Seven percent had cognitive limitations, fourteen percent were mentally or emotionally disabled, fifty-one percent had physical disabilities, fourteen percent had sensory impairments, and fourteen percent reported having multiple disabilities. This data verifies the agency's compliance with Indicator 725(b)(2) of the Act. The Empowerment Connection plans and conducts outreach strategies in order to increase the visibility of the agency and to seek and assist specific demographic or disability groups. Outreach activities proposed for the 2000/2001 fiscal year were: * Review and analysis of consumer demographic information to determine unserved and underserved consumer groups and geographic areas; * Based on demographic analysis, implementation of targeted outreach strategies; * Maintenance of five field service coordinators throughout the center's catchment area; * Completion of activities resulting in 520 hours of outreach. Based on a review of the demographic information collected from consumers in the prior program year, it was determined that specific groups to be targeted for outreach would include: * Disabled residents living in the southern region of the county; * Children and youth with disabilities; and * Minority populations. Two field service coordinators were appointed to work specifically in the southern region of the county and six satellite sites were maintained in this geographic area. Staff members participated in numerous community events and networking opportunities that were intended to benefit residents from the southern portion of Smith County. Despite these efforts, the percentage of consumers from the southern region declined from eighteen percent in the 1999/2000 program year to fourteen percent in this reporting period. This area will continue to be a primary focus in the 2001/2002 program year. Consumer representation from among children and youth increased from three to eight percent during the grant period, a 166 percent growth factor overall. This notable success was due to the development and implementation of a families and children's program at the center, which will be described in section I of this narrative. To more effectively reach non-English-speaking consumers, the center employed both a Latino and a Vietnamese field service coordinator. These staff persons acted as liaisons to their respective populations. Four satellite sites used regularly by field service coordinators were within non-English-speaking communities. Center representatives also attended events that were targeted to minority populations. One of these was Fiera del Sol in San Perez, where 175 visitors received center materials in Spanish. As a result of these efforts, a thirty-four percent increase was realized in representation from minority populations. Ongoing outreach activities conducted by the center include public relation presentations, participation in community events, representation of the center and disability issues in the media, and circulation of the agency brochure and program materials. The Empowerment Connection also hosted a special event in the program year that featured attorney general, Janet Reno, as keynote speaker. The annual "Apple of Our Eye" award luncheon was attended by approximately 260 individuals. These activities led to the completion of 1,118 outreach service hours, more than twice those recorded in the prior year. Information reported in this section of the narrative verifies the center's compliance with Indicator 725(b)(4)(d) of the Act. (C) COMMUNITY AND INDIVIDUAL INDEPENDENT LIVING SERVICES The Empowerment Connection structures service delivery so that the needs of individuals with disabilities might be addressed and so that they might achieve personal goals. The following is a summary of the projected activities in each service area and the accomplishments in the 2000/2001 program year. Because some individuals received more than one service through the agency during the reporting period, the program statistics will reflect duplication. Included in this section is performance data that verifies the agency's compliance with Indicator 725(b)(5) of the Act. Peer counseling is provided so that support and role modeling might be available for consumers and their families as they address disability-related problems and issues. This service is offered on a cross-disability basis. The proposed activities for 2000/2001 were: * Designation of qualified staff and volunteer peer counselors, who are available for referral to consumers, family members, caregivers, etc; * Coordination of a cross-disability peer support group that meets on a regular basis; * Provision of peer counseling assistance for 180 participants. Sixty-seven percent of the center's staff during the grant period was comprised of people with differing disabilities and all of these individuals were available to act as peer counselors assisting consumers in their efforts to function successfully. Five trained volunteers also served in this capacity. Four peer support groups were active, including one targeted specifically to Vietnamese participants. Twenty-five long-term peer relationships were formed and one-to-one support was offered to a total of 175 individuals. One case involved a woman with agoraphobia, who contacted the center for peer support. The client reported that the assistance she received gave her hope that she could overcome, or at least deal with, this disability. She was able to confront the problem and seek professional intervention. Over the past few years, the center has noted a tendency for consumers to seek peer support in a group setting as opposed to individual assistance. While the number of persons served were as projected, long-range peer relationships were significantly lower than anticipated. The same service profile was reported in the 1999/2000 program year. These statistics demonstrate the center's compliance with Indicator 725(b)(1)(c) of the Act. Individual advocacy is provided to assist consumers in the resolution of concerns and conflicts that affect their ability to live independently. Activities defined for the 2000/2001 grant period were: * Collection of information concerning disability laws and regulations; * Provision of relevant information and consultation to 250 consumers; * Provision of individual advocacy assistance and mediation on behalf of 130 consumers whose rights have been denied or who have experienced difficulty in obtaining needed benefits and services; * Presentation of testimony on behalf of consumers at twenty-five appeals or hearings. The advocacy unit consistently updates its reference system so that the latest legislation and regulations are available to assist consumers. During the reporting period, information and consultation was provided to 259 persons in order to enhance their access to services and benefits. Mediation and direct advocacy assistance was provided to 134 consumers. Twelve clients were represented at eligibility hearings and appeals, resulting in eight favorable decisions. A case from the advocacy component centered on the filing of a "Request for Reconsideration". This action was recommended to a consumer when the SSI he had been receiving was denied on the basis that he was no longer disabled. Because an appeal had been filed, the consumer had no interruption of benefits. Only two percent of such requests are won on appeal. With the exception of representation at hearings, activities in this program area were at or above projections, and fairly consistent with those achieved in the 1999/2000 fiscal year. Information and Referral assistance is provided to consumers and the general public regarding activities, products, and services that may be useful in the establishment and maintenance of an independent life style. The planned activities for 2000/2001 were: * Maintenance of a reference system with a broad base of information; * Provision of 2,250 hours of information and referral assistance; * Collection and dissemination of durable medical equipment for loan to sixty consumers. An extensive reference library has been developed at the center and resources were updated periodically during the reporting period. Records indicate that 546 contacts were provided with information and referrals leading to the completion of 1,024 service hours. Thirty consumers received loans of durable medical equipment through this component. One consumer contacted the center in urgent need of a wheelchair, when her own equipment needed repairs. The maintenance company had informed her that it would require several days to address the problem, during which time she would be stranded. A loaner wheelchair was provided through the information and referral program, as well as, additional options for equipment repair. Total service hours were less than anticipated, but fairly consistent with those logged in the prior program year. This may be due to the fact that apparently less time is needed with each individual and more time is required in maintaining the reference library. The service level in the equipment loan component was significantly below projection, because the center changed facilities during the grant period and many items were discarded or not returned for recirculation. The attendant referral program provides consumers and their families with options for assistance with personal care and home maintenance. The proposed activities for the reporting period included: * Recruitment and acceptance of 120 individuals, who meet established criteria as potential personal assistants; * Provision of related information and attendant referrals for 300 consumers; * Achievement of fifty-five personal assistant placements. In the program year, recruitment activities resulted in the addition of only seventy potential attendants to the registry. Low wages and a healthy job market seemed to have diminished interest in personal assistance employment. information, referrals, and/or training was provided for 214 consumers and thirty-two attendant placements were achieved. In one instance, a twenty-eight year old woman with severe cerebral palsy requested a part-time attendant to accompany her to college classes. An appropriate aid was located and the consumer is on her way to earning a degree. Service levels were significantly below anticipated, and less than those achieved in prior years, for the reasons previously noted. The center continues to advocate for improved working conditions for personal assistants. Housing assistance is available to aid consumers with the acquisition of living arrangements that meet their specific shelter needs. Projected activities for 2000/2001 were: * Collection and dissemination of current listings in various housing markets throughout Smith County; * Provision of related information and housing referrals to 300 consumers; * Achievement of sixty housing placements. Updated on a regular basis, the housing registry includes room and apartment rentals, shared housing opportunities, subsidized housing, and emergency shelter listings. In the program year, 211 individuals received information and housing referrals and twenty placements were facilitated. With the average rent for a one-bedroom apartment at or above $800, it is becoming increasingly difficult to find affordable units in Smith County for individuals with limited incomes. A case in the housing unit involved a consumer, who had been living in a motel for several months. After a three-year wait, the individual received a rental voucher through the Housing Authority. The consumer worked diligently with the housing coordinator to locate an apartment that would honor the voucher and eventually such a complex was identified. Service levels were below expectation and less than those accomplished in the previous year. It may become necessary to redefine the focus of this program component. In the meantime, the center continues to make affordable housing a priority for systems change activities. The organization provides emergency food and shelter services in an effort to address the immediate needs of persons with disabilities, who face hunger and/or homelessness. Proposed activities in this program area were: * Provision of temporary lodging for eighty-eight consumers through the operation of an emergency shelter; * Prevention of homelessness for seventy-eight individuals through the disbursement of short-term subsidies; * Assistance with the transition from temporary to permanent housing for forty program participants; * Provision of prepared meals for eighty-eight individuals during their residency at the center's shelter; * Distribution of emergency food boxes to 460 clients in order to avert hunger. At the conclusion of the first program quarter, it was the decision of the governing board to close the emergency shelter owned by the center. This step was taken due to rising program costs and increasing liability. Prior to this action, eighteen individuals had resided at the shelter. The agency continued to engage in homelessness prevention through the provision of financial aid. During the program year, ninety-eight families, inclusive of 150 persons, received such assistance. Fifty-nine individuals were aided to transition into permanent housing. Food boxes were distributed to 223 individuals, who were having difficulty purchasing sufficient groceries. The emergency services component successfully assisted a woman with a mental disability, who had been living on the streets for more than two years. While staying at HEARTH, she participated in both the peer support and independent living skills training components. The housing coordinator was able to refer the consumer to the Shelter Plus Program and she was provided with a rental assistance certificate. She is currently in her own apartment. Activity in the area of homelessness prevention exceeded projections and was slightly higher than in the previous year. The distribution of food boxes was both below expected and less than that accomplished in the prior reporting period. It is usually difficult to accurately predict service levels, because performance is dependent on funds obtained for these purposes. Independent living skills training is provided in an effort to enhance the ability of consumers to become and remain self-sufficient. The projected activities for the grant period were: * Provision of instruction, technical assistance, and related services for 200 consumers; * Attainment of independent living plans for all program participants; * Achievement of seventy percent of the goals defined in the training plans of consumers. Independent living skills training was provided primarily through the Aging With Vision Loss Program, however, the field service coordinators also offered individual instruction. During the program year, ninety-seven individuals received this service and goals were met at a thirty-five percent success rate. It is important to note that most participants in this service area received a minimum of thirty hours of training and that the percentage of goals attained was low, because many people were still working on the fulfillment of their independent living plans at the end of the program year. Performance levels were both below projected and less than those accomplished in the prior grant period. The independent living counselor for the blind was contacted by an older woman that had been loosing her eyesight as the result of macular degeneration. She was no longer able to prepare her own meals and was frustrated, because she felt isolated from community life. The counselor, who is herself blind, went to the client's home and provided adapted cooking instructions. She also linked the client with a group of blind persons who meet regularly for recreational activities. Initially, transportation services were provided to assist consumers at the emergency shelter to travel to and from appointments and in training programs to enhance orientation and mobility. The activities proposed for the reporting period were: * Provision of bus tokens and passes for eighty-five consumers; * Enhancement of mobility skills for sixty consumers through training and orientation. With the closure of the center's shelter, transportation assistance was limited to independent living skills training. The center received Title VII Ch. 2 funding to provide taxi vouchers for older persons with severe visual loss. Fifty-two consumers took advantage of this assistance. Because of the restructuring of this service, the activity levels were below projections and less than those achieved in the previous reporting period. Communication assistance is offered through the Empowerment Connection so that persons with sensory impairments might interact effectively with others. Planned activities included: * Enhancement of communication for 360 consumers through the provision of 3,240 interpreter/reader placements; * Provision of interpretation services in seventy medical emergencies; * Recruitment and evaluation of twenty interpreters for inclusion in the communication registry. At the end of the program year, communication assistance had been provided for 288 consumers; 9,872 service hours had been completed; sixty-nine individuals had received interpreter assistance in medical emergencies; and the program registry included sixty-seven qualified interpreters. Consumers were tracked only if it became necessary to open a file on their behalves. Generally, assistance was provided at the request of a public or private entity and not an individual. One outstanding case that was handled by the communications department involved a fifty-six hour labor and delivery situation in which the mother-to-be was deaf. Qualified sign language interpreters enhanced communication with the medical staff and eventually the patient gave birth to healthy twins. In general, projected activities were accomplished and remained fairly consistent with program performance in the prior reporting period. After sixteen years in the same location, the Empowerment Connection moved its main offices to the city of Grapevine. A 20,460 square foot, fully accessible facility was leased by the center. Both this site and the branch office are near public transportation lines that use lift-equipped vehicles. TDD access is provided and communication assistance is available to consumers upon request. Program materials are produced in alternate formats. These measures allow the center to comply with Indicator 725(b)(1)(D) of the Act. (D) INDIVIDUALS SERVED BY COUNTY The service area of the Empowerment Connection encompasses only one county, however, programs are conducted out of two offices. While the agency did not predict the number of unduplicated clients that would be served through each site, it is possible to report that 1,272 unduplicated consumers were aided through the main office and 210 were served through the branch office. The number of persons assisted through this Title VII C grant was only five less than those aided in the previous grant period. (E) CONSUMER SATISFACTION The Empowerment Connection implements procedures to provide consumers with opportunities to express satisfaction or dissatisfaction with center services and policies in facilitating achievement of individual independent living goals. Specific activities planned for the reporting period were: * Dissemination of the "How's The Service?" form to all consumers upon completion of assistance; * Allotment of time for public comment during board meetings so that consumers might share their evaluation of center programs before the governing body; * Coordination of a consumer advisory committee as one mechanism for the acquisition of input regarding agency performance; * Completion of an annual analysis and summary of evaluation data; * Presentation of findings to the governing board, the SILC, and the Rehabilitation Services Agency. The primary procedure for obtaining input from consumers regarding their assessment of the Empowerment Connection is through the distribution of a brief evaluation form. a satisfaction questionnaire is mailed to individuals so that they might rate the assistance provided, identify any difficulties encountered with service delivery, and recommend methods for improvement. In the 2000/2001 program year, 319 questionnaires were disseminated to individuals using the agency's services and an eleven percent return rate was attained. Seventy-three percent of the respondents rated the assistance received as excellent, twenty-one percent rated the services as good, and six percent designated a poor rating. Returned evaluations were reviewed by the management team, THE COMPREHENSIVE RESULTS WERE FORWARDED TO THE GOVERNING BOARD, and reported herein to RSA and the State Independent Living Council. Although the number of evaluation forms disseminated was lower than in the previous year, the return rate was higher. The ranking of performance was fairly consistent with that reported in the prior grant period. While a public comment section was included in each agenda of the governing board, no consumers took advantage of this opportunity to express satisfaction with the center nor to address problems encountered in service delivery. A consumer advisory committee was not formed in the program year, however, the four peer support groups offered suggestions regarding program implementation at the agency. The procedures defined in this section of the narrative are evidence of the center's compliance with Indicator 725(b)(3) of the Act. (F) RESPONSE TO NEEDS Information is gathered and reviewed from the community and individuals with disabilities on an ongoing basis to assure that the center's current service plan is consistent with consumer demands and that emerging or changing needs are identified. Specific activities defined for the reporting period were: * Prioritization of unmet needs within the disability community of Smith County; * Identification of strategies to address defined needs; * Participation in the development of resources to address specific needs within the center's catchment area. Based on a review of data collected through a county-wide needs assessment conducted by the center, an analysis of consumer requests for assistance, input from other disability-related organizations, and findings of the California Needs Assessment conducted by the State Independent Living Council, the Empowerment Connection set the following priorities in its long-range plan: * Improving accessible transportation for people with disabilities; * Increasing affordable housing options; * Expanding outreach to unserved and under-served populations; * Promoting a powerful and integrated image of the center within the community; * Advancing the employment of people with disabilities; * Enhancing access to the agency and independent living resources through information technology; * Increasing organizational capacity through volunteerism. As previously described in this report, much of the systems advocacy conducted by the center dealt with the issues of accessible/affordable housing and appropriate public transportation and paratransit services. Outreach was accelerated so that assistance to unserved and underserved consumer groups might be expanded. The agency pursued and obtained funding to initiate a new employment services program. Recruitment and use of volunteers continued to increase during the program year. While progress was achieved toward the desired outcomes, these priorities will remain the focus for the duration of the current strategic plan. Performance was consistent with both projected activities, as well as, accomplishments in the prior reporting period. During the formation of the assistive technology program, (see section I of this narrative), the organization collected data in order to identify and prioritize the needs and interests of consumers in Smith County. The agency gathered written input from seventy-eight individuals and conducted six public forums to obtain oral testimony concerning issues related to assistive technology. Additional input was obtained through discussions with numerous contacts at outreach events such as an ADA exposition for the judicial community in Costa Mesa, a Disability Symposium at Cal. State University, Fullerton, and "Building Bridges Together: Preparing Adolescents with Special Health Care Needs for Adulthood" conference held in Pasadena. An analysis of findings revealed the following information. Most respondents were virtually unaware of the various types of assistive technology nor did they know where to go to access such information. Those, who had attempted to acquire AT products and services, stated that the process was overwhelming and extremely stressful. Often the time between obtaining approval for assistive technology and actually attaining the merchandise was so great that the items were outdated upon receipt and the consumers themselves were not eligible for upgrades. Respondents reported frustration with the fact that little or no training or technical support was available to assist them in successfully using AT. Many felt that there was a need for the formation of peer links so that they could benefit from the knowledge and experience of other people with disabilities using similar assistive technology. Others said that they did not know how to choose suitable products or how to locate appropriate vendors. Some did not have access to the Internet and stated that they were unable to use community resources such as those at public libraries, because of the lack of transportation and/or accessibility. Many stated that there was no coordination between agencies providing AT assistance to people with disabilities and that often service providers seemed apathetic to the AT needs of their consumers. Without a doubt, the primary barrier to the acquisition and use of assistive technology, identified by survey participants, was the lack of adequate financial resources for this purpose. According to the National Institute on Disability Research, two thirds of all assistive technology is purchased by consumers themselves or by family members. The availability of subsidies or low interest loan programs has been pegged as one of the most prevalent needs in the center's service area. In the coming months, the agency will work to identify potential resources for this purpose. (G) RESOURCE DEVELOPMENT The governing board and administrative staff of the Empowerment Connection are involved in the development of diverse financial resources so that the organization might have a solid funding base. In the 2000/2001 fiscal year, the planned activities were: * Formulation of a comprehensive development plan; * Implementation of fund raising activities accounting for six percent of the center's total revenues; * Acquisition of donations and grants from private sources comprising nine percent of the agency's income for the 2000/2001 fiscal year; * Attainment of earned income resulting in thirty percent of the organization's operational funds; * Acquisition of in-kind contributions of products and services with a cash value of $15,000; * Expansion of the funding base for the operation of the center's branch office. A development council composed of leaders from the public and private sectors was formed to plan and coordinate fund raising activities. The agency retained a grant consultant, who produced approximately seventy applications and funding requests. Overall results of these efforts are as follows: three percent of the organization's revenues were obtained through fund raising activities, (below projections, but higher than in the 1999/2000 fiscal year); six percent of the organizational income came from private grants and donations, (below both projections and performance in the prior year); nineteen percent of the agency's resources were generated through fees, (below projections and performance in the previous reporting period), in-kind contributions with an estimated cash value at one percent of the total budget were received by the organization, (well above expectation, as well as, achievement in the prior fiscal year); and revenues obtained for the operation of the branch office increased slightly over the prior reporting period. The center obtained twenty-nine percent of its income through non-governmental sources as compared to thirty-six percent in the 1999/2000 fiscal year. While the organization's income expanded significantly during the grant period, most of the additional revenues came from public sources. This information reflects the agency's compliance with Indicator 725(b)(6) of the Act. (H) TRAINING The Empowerment Connection facilitates the provision of training for personnel AND VOLUNTEERS so that knowledge and skills might be improved and expanded. Activities planned for the 2000/2001 program year were: * Coordination of a board training session relevant to the duties and responsibilities of governing officers; * Designation of at least one specific training objective for each employee; * Arrangement for in-service training at six general staff meetings. Two training sessions were conducted with the governing board during the reporting period. One addressed the role and duties of directors and the other dealt with casting a vision for the agency, adopting a mission, and setting annual goals. Records indicate that personnel attended more than thirty separate training sessions, many lasting for several days. Topics were diverse and included "Training Busy Staff to Succeed with Volunteers", "How to Produce Fabulous Fund Raising Events", "Accessing The Media", "Promoting Preventive Health for Asian and Pacific Islander Communities", understanding work incentives, recent developments in assistive technology, and "Outcomes Measurement." In-service training was provided to all employees at eight general staff meetings. Subjects that were addressed included stress management, dealing with clients in crisis, and using Augmentative Communication. Several instructional videos were viewed by all personnel. The videos dealt with topics such as"Spasticity Released: A Treatment Alternative", "Life as it Should Be", "Front-line: A Class Divided", and "Disability is Not The Issue, Opportunity Is". The full staff also participated in the training retreat along with the board regarding the adoption of the vision, mission, and goals for the organization. Board and general staff training exceeded projections and was higher than in the previous year. Training for individual staff members was consistent with both projections and performance in the prior reporting period. (I) INNOVATIVE ACTIVITIES The Empowerment Connection implemented several innovative projects during the grant period. One of these was a comprehensive program to support and strengthen families for the optimal development of their young children with disabilities. This program has three priorities: * To assure that targeted families are aware of, and have access to, public services and benefits; * To increase parenting skills for effective child rearing; and * To empower families with disabled children through peer and professional support. Services provided in the grant period included: * Professional counseling through an on-staff licensed therapist; * Parent training using the STEP curriculum, (Systematic Training for Effective Parenting", * Parent support groups, and core independent living services. Ninety families participated in this component during the 2000/2001 program year. The high point of the reporting period was a two-day workshop on the dynamic applied theory of the grieving process, sponsored by the center and conducted by Dr. Ken Moses, a nationally recognized psychologist and parent of a child with a disability. Seventy-five parents and 380 professionals attended this training. In 2000, the Empowerment Connection piloted a project entitled The Pumpkin Shell Play Group for Children With Disabilities. The program has two goals: (1) To reduce the stress and strain of parenting; and (2) To enhance the social, emotional, and intellectual development of children, who are severely disabled. Toward the attainment of these goals, the center developed a safe and enjoyable environment, where children with disabilities can play, while their parents attend to business or simply take a break. The playgroup is available twice monthly and is staffed by a project coordinator and a registered nurse. a licensed family counselor is also present to provide professional intervention when needed. Several teens with disabilities have also become involved in the project and have volunteered as assistants in the playgroup. Twenty-eight families participated in the project during the year and children with a variety of disabilities benefited from this opportunity. The groups have not been merely "baby sitting" sessions, but avenues for experiences with art and music and for social interaction. One father was amazed when his son, who is autistic, linked with another child, and the two developed their own communication pattern. Recently, the center received an additional grant to expand the playgroup to include a weekend session and to create another group for siblings of children with disabilities. Another new program of the Empowerment Connection is assistive technology, (AT), which encompasses any equipment, devices, assistance, or structural modifications that enhance the ability of people with disabilities to live independently. The Center is in the process of developing an AT lab for consumer use. A variety of low and high tech equipment and devices will be available for assessing the specific needs of individuals and for demonstration and training. In addition to operating the lab, the center sponsors and/or presents consumer education workshops to inform people of the role that assistive technology might play in the establishment and maintenance of an independent lifestyle. Service coordination is provided for consumers, who request assistance in researching various assistive technology options, identifying potential funding sources for acquisition, obtaining appropriate assessments, and using and maintaining equipment. During the first program year, AT information and referral was offered to approximately 800 contacts and 109 individuals received direct services related to assistive technology. The Empowerment Connection is among several independent living centers throughout the country that entered into cooperative agreements with the Social Security Administration to provide a benefits planning and outreach program for SSI and SSDI recipients. The primary goals of this project are: (1) To improve the understanding of options and incentives so that people with disabilities might make more informed decisions regarding employment; and (2) To assist SSA in assessing the scope and usefulness of outreach and benefits planning as strategies to increase the acquisition of gainful employment and the demonstration of self-sufficiency among beneficiaries. Referred to as the WISE, (Work Incentive Solution Exchange), Program, the project has been marketed throughout Smith County. targeted organizations and groups have included One-Stop Career Centers, area offices of the Department of Rehabilitation and Regional Center, Braille Institute, and the Brain Injury Network. Along with continuing to target public and private agencies and consumer groups, outreach in the coming year will be directed to high-schools so that youth with disabilities and their families are aware of benefits planning and assistance offered through the WISE Program. Outreach efforts will also be accelerated within non-English-speaking populations. Educational sessions are presented to provide substantive information regarding various incentive programs to SSI and SSDI recipients, family members, payee representatives, service providers, and disability professionals. Approximately seventy individuals with disabilities and forty professional persons received such training during the initial grant period. Benefits specialists gather and analyze information pertinent to the benefits management plan; advise beneficiaries and their support teams regarding financial status before, during, and at the conclusion of benefits; aid with the application for, or preparation of, documentation for various work incentive benefits; advocate on behalf of consumers with other agencies and programs; and provide information, referrals, and problem-solving support. Seventeen benefits plans were developed in the reporting period. This program will continue in the 2001/2002 program year. The Empowerment Connection is in the process of launching an extensive employment services component. Approximately $500,000 from public and private sources have been committed for this purpose. Services will include employment preparation, job development and placement, and post employment assistance. The program will be targeted to individuals having severe disabilities and to consumers, for whom English is not their primary language. (J) CONSISTENCY WITH STATE PLAN FOR INDEPENDENT LIVING The purpose of the current California State Plan for Independent Living is to promote the philosophy of independent living as defined by the Rehabilitation Act as amended. The mission of the Empowerment Connection meets this intent. Furthermore, the programs and activities of the organization effectively implement the federal and state core services required in Attachment 12 Sections A and B of the State Plan. No specific activities were defined in this regard for the 2000/2001 reporting period. (K) SUBSTANTIAL PROBLEMS OR DIFFICULTIES EFFECTING COMPLIANCE WITH INDICATORS Following an agency review conducted by the Department of Rehabilitation in 1999, the Empowerment Connection was certified as having met the indicators established for the operation of independent living centers defined in Title VII of the Rehabilitation Act. The organization has taken steps to address areas of weakness identified by the reviewers. In general, these deficiencies dealt with the attainment of consumer input concerning program planning and evaluation and the maintenance of more complete case files. The consumer evaluation form has been simplified and is automatically dispersed to all new clients. It is also the intent of the center to retain a consultant to conduct community focus groups throughout the year as another means of gaining input. The consumer data forms have been revised and program staff has received additional training in file maintenance. RSA has informed the executive director that it will conduct a compliance review of the Empowerment Connection in the spring of 2002. Subpart II-F-I CIL WORK-PLAN FOR THE 2002/2003 FISCAL YEAR This section of the report will define the goals and activities, by category, to be undertaken by the Empowerment Connection in the 2002/2003 fiscal year and will predict the anticipated outcomes that will occur as the result of these activities. (A) ADVOCACY EFFORTS COMMUNITY ACTIONS Systems Advocacy Goal: To facilitate equal access for persons with disabilities and to increase options for independent living. Activities: * Implementation of strategies to impact priority issues defined in the center's long-range plan; * Identification of immediate issues that require policy or procedural change to better meet the needs of persons with disabilities; * Participation in twelve administrative or advisory bodies that have the capacity to facilitate system changes; * Advancement of self-advocacy opportunities among consumers. Outcomes: * 800 hours of systemic advocacy will have been recorded; * Significant improvement will have been documented in at least one of the issues addressed. Technical Assistance Goal: To serve as a qualified resource to the community. Activities: * Provision of information and support to organizations seeking to replicate policies, procedures, projects, or programs of the center; * Provision of information and assistance through the World Wide Web; * Consultation to twenty entities in the public and private sectors to facilitate compliance with disability laws and regulations and to enhance community integration. Outcomes: * Six organizations will have enhanced capacity to serve people with disabilities; * 1,200 individuals will have gained information and assistance through the agency's web site; * Program and structural accessibility will have improved throughout the service area; * The agency's sphere of influence will have increased. Collaboration Goal: To maximize the center's performance through shared resources and community relations. Activities: * Maintenance of cross-referrals systems with other organizations; * Participation in fifteen agency coalitions and/or service networks; * Maintenance of membership in six business associations; * Provision of contracted services for sixty agencies and/or businesses. Outcomes: * Consumers will have benefited from inter-agency service coordination; * Twelve satellite sites will have been maintained through donated office space; * The center will have been a participant in two collaborative proposals or projects. Public Education Goal: To heighten awareness concerning disability-related issues. Activities: * Enlistment of staff and volunteers as spokespersons for the disability movement; * Notification to the public that disability awareness presentations are available through the center; * Coordination of one educational campaign concerning a specific issue; * Production and distribution of a quarterly newsletter. Outcomes: * 800 hours of public education activities will have been completed; * Fifty presentations will have been conducted; * Audiences will exhibit increased awareness of the subjects addressed; * The agency newsletter will have been disseminated to 3,000 readers; * 800 publication hours will have been reported. LEGAL ACTION Goal: To protect the rights of people with disabilities and the viability of the organization. Activities: * Investigation of blatant acts of noncompliance with relevant laws and regulations; * Pursuit of voluntary resolution and compensation; * Adherence to all applicable labor laws and regulations relevant to the operation of nonprofit organizations. Outcomes: * Violations of disability rights and regulations will have been addressed and corrected; * The center will have exhibited fiscal and programmatic responsibility at all times. (B) Outreach Goal: To expand assistance to unserved and underserved populations and to increase the center's visibility throughout Smith County. Activities: * Review and analysis of demographic information to determine unserved and underserved consumer groups and geographic areas; * Development and implementation of specific strategies to reach targeted groups; * Coordination of ongoing outreach activities. Outcomes: * Fifty outreach activities will have been recorded; * Representation from unserved and underserved groups and areas will have increased; * 1,000 hours of outreach will have been completed. (C) Community and Individual Independent Living Services Goal: To assist consumers in achieving personal goals pertinent to independent living. Activities By Program Area: Peer Counseling * Maintenance of a pool of qualified staff and volunteers willing to act as peer counselors; * Coordination of three cross-disability peer support groups that meet regularly; * Initiation of thirty long-term peer relationships. Outcomes: * 180 consumers and/or significant others will have received support to address issues related to disability and living independently. Individual Advocacy * Collection of, and familiarity with, information concerning disability laws and regulations; * Dissemination of information concerning various entitlement programs and provisions of disability and human rights legislation; * Investigation of ten alleged violations of applicable laws and regulations; * Consultation to, and mediation on behalf of, 130 consumers whose rights have been denied or who have experienced difficulty in obtaining needed benefits and services; * Representation of consumers in twelve appeals or hearings. Outcomes: * Consumers will demonstrate improved understanding of entitlement programs; * Satisfactory decisions will have been obtained in eight appeals or hearings; * Conflicts will have been resolved that blocked the ability of consumers to obtain needed benefits and services. Benefits Planning and Outreach * Development and fulfillment of a comprehensive outreach plan to inform 900 contacts from target groups of benefits planning and assistance services available through the center; * Provision of consumer education regarding various work incentive programs to 180 SSI and/or SSDI recipients; * Presentation of training for sixty service providers and disability professionals concerning legislation and regulations designed to increase the employability of people, who are disabled; * Provision of benefits plan management and assistance for ninety-six SSI and/or SSDI beneficiaries. Outcomes: * The community will be more aware of work incentive programs designed to promote the employment of people with disabilities; * Participating SSI and SSDI beneficiaries will exhibit reduced anxiety and increased willingness to seek employment. Attendant Referral * Expansion of the attendant registry through recruitment efforts; * Provision of potential attendant referrals, information regarding funding through In-home Supportive Services, and instruction concerning attendant management to 200 consumers. Outcomes: * 300 hours will have been recorded in the maintenance of the registry; * Twenty-five individuals will have been approved for In-home Supportive Services; * Forty attendant placements will have been facilitated. Housing Assistance * Collection and dissemination of current listings in various housing markets throughout Smith County; * Provision of related information and housing referrals to 200 consumers; * Provision of assistance with requirements or procedures to facilitate the acquisition of rental subsidies or home modifications. Outcomes: * 300 hours will have been completed in expanding and updating housing listings; * Thirty housing placements will have been achieved; * Thirty consumers will have received specialized assistance concerning options for accessibility or affordability. Emergency Food and Shelter * Provision of technical assistance and staff consultation to facilitate access within community shelters; * Provision of ancillary services for homeless persons with disabilities residing at temporary facilities in the area; * Prevention of homelessness through short-term financial assistance to eighty consumers; * Distribution of emergency food boxes to 240 consumers. Outcomes: * All of the shelters in the county will meet ADA and 504 compliance; * Fifty individuals will have received supportive services to aid with the transition from homelessness to stability; * Thirty evictions will have been averted; * Fifty consumers will have received assistance with move-in costs; * 2,400 boxed meals will have been provided. Information and Referral * Maintenance of a reference system with a broad base of information; * Provision of information and referral assistance to 700 contacts; * Collection, repair, and cleaning of durable medical equipment for loan to consumers. Outcomes * 300 hours will have been completed in the maintenance of the reference system; * 700 hours of information and referral assistance will have been provided; * Twenty consumers will have received loaned medical equipment. Independent Living Skills Training * Administration of an independent living skills/services component targeted to older persons, who are loosing their eyesight; * Maintenance of four field service coordinators to offer one-to-one IL services and skills training to consumers in their homes and surrounding communities; * Development of independent living plans with 200 consumers; * Provision of independent living services and/or training as defined in the ILP's of consumers. Outcomes: * Sixty percent of the stated goals recorded in the plans of participating consumers will have been reached; * The self-sufficiency of those receiving IL services and training will have been increased. Communication Assistance * Expansion of the sign language interpreter registry through recruitment and evaluation; * Implementation of a system for receiving and filling requests for communication assistance. Outcomes: * The interpreter registry will have been expanded through 300 service hours; * 9,000 hours of communication assistance will have been documented; * Seventy-five persons with hearing impairments will have been provided with interpreter services during medical emergencies. Assistive Technology * Completion of 20 outreach activities regarding assistive technology for people with disabilities; * Operation of an assistive technology lab that will have been used by 100 consumers; * Expansion of the assistive technology reference database through completion of 300 service hours; * Provision of 1,200 referrals to 600 contacts concerning all types of assistive technology; * Presentation of training relevant to technology for 30 consumers; * Provision of case coordination in order to heighten the ability of 60 consumers to acquire and use assistive technology; Outcomes: * People with disabilities will have had access to equipment and devices and will have tested their usefulness prior to purchase; * Training will have reduced anxiety and increased self-confidence among consumers seeking to use assistive and information technology; * Consumers will possess adequate knowledge of equipment and devices to facilitate successful selection and use. Family Services * Initiation of specific outreach activities to identify families having infants or preschoolers with disabilities, who require assistance regarding issues related to independent living; * Provision of supportive services and/or case management for 100 families annually; * Presentation of four parenting courses based on the STEP Program and other curricula; * Sponsorship of an all-day workshop targeted to parents and professionals; * Provision of personal counseling for 40 family members to aid with the adjustment to disability and its impact on individual and family functioning; * Coordination of 16 meetings of parent support groups so that families might share knowledge, experiences, and feelings; * Administration of play groups for children with disabilities and for siblings; Outcomes: * Participating families will have gained peer and professional support to enhance the emotional, social, and mental development of their young children with disabilities; * Family relationships will have been strengthened; * Professionals will be better prepared to assist families having youngsters with disabilities. Employment Services * Presentation of employment preparation training to 300 consumers of the Department of Rehabilitation, including 80, who are blind or visually impaired, 43, who are Vietnamese, and 110, who are Hispanic; * Identification of job leads through interaction with human resource departments and potential employers; * Formation of a business advisory committee to enhance program implementation; * Provision of post-employment assistance regarding reasonable accommodation and other issues for those participants requesting such assistance; Outcomes: * 1,500 hours will have been completed in job development activities; * 186 job placements within the targeted consumer groups will have been facilitated; * A 90-day job retention rate will have been reached among 128 of those individuals placed in employment. (D) Individuals Served Per County Goal: To achieve consumer distribution that is in parity with the population of Smith County. Activities: * Implementation of ongoing outreach efforts throughout the service area; * Maintenance of sufficient staff to assure countywide coverage; * Operation of two offices to enhance consumer access to center programs and services. Outcomes: * 1,300 unduplicated clients will have been assisted through the agency's main offices; * 250 consumers will have been served through the center's branch office. (E) Consumer Satisfaction Goal: To provide opportunities for consumers to express satisfaction or dissatisfaction with policies, procedures, and services encounter through their interaction with the agency. Activities: * Dissemination of the "How's The Service?" form to all new consumers upon completion of assistance; * Scheduling of time for public comment during board meetings so that consumers might share their assessment of center programs before the governing body; * Coordination of focus groups to gain input from the community; * Provision of a mechanism for consumer evaluation through the agency's web site; * Completion of an annual analysis and summary of evaluation data; * Presentation of findings to the governing board, the SILC, and the Rehabilitation Services Agency. Outcomes: * Evaluation forms will have been dispersed to at least 400 consumers; * A return rate of fifteen percent will have been obtained; * Eighty percent of all those providing input regarding the effectiveness of the center will have expressed satisfaction with the policies and practices of the organization. (F) Response To Needs Goal: To consider data collected from the community and the agency's constituency in program planning and resource development. Activities: * Periodic assessment of the prioritization of unmet needs within the disability community as defined in the center's long-range plan; * Revision of existing strategies or determination of new approaches to address defined needs; * Modification of service delivery system when indicated; * Initiation of systemic advocacy to address specific concerns; * Pursuit of funding through sources that prioritize issues related to areas of unmet need. Outcomes: * Evidence will indicate that notable improvement has occurred in one of the primary areas of concern; * The capacity of at least one service area of the agency will have been expanded or improved; * One new program or project will have been developed to address an identified gap in services. (G) Resource Development Goal: To build and strengthen the funding base for the organization. Activities: * Implementation of diverse funding strategies; * Expansion of the development staff and council for greater effectiveness; * Improvement of the use of resources to maximize fiscal performance. Outcomes: * Thirty-five percent of the agency's revenues will have been obtained from non-public sources; * The center's funding base will have been expanded five percent over the prior year; * All programs will have had sufficient income to function at full capacity. (H) Staff, Board, and Consumer Training Goal: To enhance the professional abilities of staff and volunteers and the self-sufficiency of persons with disabilities. Activities: * Coordination of a board training session relevant to the duties and responsibilities of governing officers; * Initiation of training opportunities for individual employees; * Arrangement for in-service training at six general staff meetings; * Presentation of four consumer workshops related to independent living. Outcomes: * The Board of Directors will have demonstrated a higher level of functioning; * Eighty percent of the agency's personnel will have exhibited greater professionalism and productivity; * A higher percentage of consumers will have been more successful in attaining their independent living goals. (I) Innovative Activities Goal: To demonstrate creativity in program planning and implementation. Activities: * Interaction with other service providers to explore new and different methods of assisting consumers; * Review of "Best Practices" studies related to the provision of independent living services; * Determination of programs that have the potential to augment core independent living services. Outcomes: * One pilot project will have been successfully implemented during the reporting period. (J) Consistency With State Plan For Independent Living Goal: To act as an agent in the fulfillment of the SPIL and to demonstrate compatibility with the objectives and intent of the Plan. Activities: * Periodic review of the SPIL to maintain familiarity with its various components; * Provision of relevant input to the State Independent Living Council regarding the implementation and effectiveness of the current Plan; Outcomes: * The agency will have demonstrated compliance with the current SPIL. (K) Substantial Problems Or Difficulties In Maintaining Compliance With Standards And Indicators Goal: To meet the requirements defined in Title VII of the Rehabilitation Act for the operation of independent living centers. Activities: * Implementation of periodic internal reviews to monitor assurances; * Identification of potential difficulties; * Formulation of needed corrective actions. Outcomes: * The Empowerment Connection will have addressed issues in a timely manner, thus circumventing problems or difficulties in maintaining compliance with all standards and indicators of the Act. Subpart IIFII - Training and Technical Assistance Needs for the Next Fiscal Year Training and Technical Assistance Needs Choose up to 10 Priority Needs --- Rate items 1-10 with 1 being most important Advocacy/Leadership Development General Overview Community/Grassroots Organizing Individual Empowerment 6 Systems Advocacy 3 Legislative Process APPLICABLE LAWS General overview and promulgation of various disability laws Americans with Disabilities Act Air-Carrier's Access Act Fair Housing Act Individuals with Disabilities Education Act Medicaid/Medicare/PAS/waivers/long-term care Rehabilitation Act of 1973, as amended Social Security Act Workforce Investment Act of 1998 Ticket to Work and Work Incentives Improvement Act of 1999 Assistive Technologies General Overview Data Collecting and Reporting General Overview 704 Reports Dual Reporting Requirements Case Documentation Disability Awareness and Information Specific Issues Evaluation General Overview CIL Standards and Indicators Community Needs Assessment Consumer Satisfaction Surveys Focus Groups Government Performance Results Act and Title VII Outcome Measures Financial: Grant Management General Overview Federal Regulations Budgeting Fund Accounting Financial: Resource Development General Overview Diversification of Funding Base Fee-for-Service Approaches For Profit Subsidiaries Fund-Raising Events of Statewide Campaigns Grant Writing Independent Living Philosophy General Overview Innovative Programs Best Practices 1 Specific Examples Management Information Systems Computer Skills Software Marketing and Public Relations General Overview 5 Presentation/Workshop Skills 2 Community Awareness 4 Networking Strategies General Overview Electronic Among CILs & SILCs Community Partners Program Planning General Overview of Program Management and Staff Development CIL Executive Directorship Skills Building Conflict Management and Alternative Dispute Resolution First-Line CIL Supervisor Skills Building IL Skills Modules Peer Mentoring Program Design Time Management Team Building Outreach to Unserved/Underserved Populations General Overview Disability Minority Institutionalized Potential Consumers Rural Urban SILC Roles/Relationship to CILs General Overview Development of State Plan for Independent Living Implementation (monitor & review) of SPIL Public Meetings Role and Responsibilities of Executive Board Role and Responsibilities of General Members Collaborations with In-State Stakeholders CIL Board of Directors General Overview Roles and Responsibilities Policy Development Recruiting/Increasing Involvement Volunteer Programs General Overview Optional Areas and/or Comments (write-in) Subpart IIG - Budget Summary Public reporting burden for this collection of information is estimated to vary from 13 to 22 hours per response, with an average of 17.5 hours per response, including the time reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Education, Information Management and Compliance Division, Washington, D.C. 20202-4651; and the Office of Management and Budget, Paperwork Reduction Project 1875-0102, Washington DC 20503. INSTRUCTIONS FOR ED FORM 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 program 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, columns (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 project 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 or other 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. U.S. DEPARTMENT OF EDUCATION BUDGET INFORMATION NON-CONSTRUCTION PROGRAMS OMB Control Number: 1890-0004 Expiration Date: 02/28/2003 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 8. Other 9. Total Direct Costs (lines 1-8) 10. Indirect Costs 11. Training Stipends 12. Total Costs (lines 9-11) ED Form No. 524 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 B - 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 8. Other 9. Total Direct Costs (lines 1-8) 10. Indirect Costs 11. Training Stipends 12. Total Costs (lines 9-11) SECTION C - OTHER BUDGET INFORMATION (see instructions) ED Form No. 524 signatures, Printed name, Title, phone Numbers Please sign and print your name, title and your phone number. Signature of Center Director date Name and title of Center Director phone number Signature of Board Chairman date Name and title of Board Chairman phone number Report Submission Information Please Mail: (A) One (1) hard copy and One (1) electronic (WORD) copy - To RSA Regional Office. The hard copy will serve as the official copy of the 704 Report. If you do not have access to email, please provide your electronic copy on disk. (See transmittal letter for contact information.) (B) One (1) electronic (WORD) copy - To RSA Central Office. If you do not have access to email, please provide your electronic copy on disk. Send to attention of: Roslyn Thompson at email: roslyn.thompson@ed.gov -or- Attn: Roslyn Thompson U.S. Dept. of Education 330 C Street, SW MES Rm. 3328 Washington, D.C. 20202-2649 (C) One (1) electronic (WORD) copy - To Independent Living Research Utilization at TIRR. Send to: Dawn Heinsohn at email: Heinsohn@bcm.tmc.edu -or- Attn: Dawn Heinsohn ILRU 2323 South Shepherd, Ste. 1000 Houston, TX 77019 (D) One copy - To the Statewide Independent Living Council. Due Dates: For 722 States - Copies must be sent no later than December 31, 2001. For 723 State - Copies must be sent no later than January 31, 2002. 704 Report Parts I & II November 7, 2001 Dear Colleagues: Enclosed is the 704 Report, Parts I and II. Part I is to be completed by the DSU and Statewide Independent Living Council. Part II is to be completed by Part C funded Centers for Independent Living. Four (4) copies of this Report shall be submitted in the following manner: (A) One (1) electronic (WORD) copy and one (1) hard copy with signatures shall be sent to your RSA regional office. The hard copy shall serve as the official copy of the 704 Report. If you do not have access to email please provide electronic (WORD) copy on disk. Below is a listing of regional contacts: Region 1 - CT, ME, NH, RI, VT, MA Mail to: Mr. John Szufnarowski, RSA Regional Commissioner Dept. of Education, OSERS J.W. McCormack Post Office and Court House Rm 502 Boston, MA 02109 Email: john.szufnarowski@ed.gov Region 2 - NJ, PR, VI, NY Mail to: Mr. Gennaro Iodice U.S. Department of Education Rehabilitation Services Administration C/O NYC Board of Education 65 Court Street, 12th Floor Brooklyn, New York 11201 Email: gennaro.iodice@ed.gov Region 3 - DC, DE, MD, VA, WV, PA Mail to: Dr. Ralph Pacinelli, RSA Regional Commissioner Dept. of Education, OSERS The Wanamaker Building, Suite 512 100 Penn Square East Philadelphia, PA 19107 Email: ralph.pacinelli@ed.gov Region 4 - AL, FL, KY, NC, SC, TN, GA, MS Mail to: Ms. Sue Rankin-White, IL Program Specialist Dept. of Education, OSERS 61 Forsyth St. SW Suite 18T91 Atlanta, GA 30303-3104 Email: sue.rankin-white@ed.gov Region 5 - IN, MI, MN, OH, WI, IL Mail to: Ms. Kathleen Niemi Dept. of Education, OSERS 111 N. Canal Street Rm. 1048 Chicago, IL 60606 Email: kathleen.niemi@ed.gov Region 6 - AR, LA, NM, OK, TX Mail to: Mr. Loerance Deaver, RSA Regional Commissioner Dept. of Education, OSERS 1999 Bryan St. Rm. 2740, Harwood Center Dallas, TX 75201-6817 Email: loerance.deaver@ed.gov Region 7 - IA, KS, NB, MO Mail to: Dr. Douglas Burleigh, RSA Regional Commissioner Dept. of Education, OSERS 10220 N. Executive Hills Blvd Kansas City, MO 64153-1367 Email: douglas.burleigh@ed.gov Region 8 - MT, ND, SD, UT, WY, CO Mail to: Mr. Loerance Deaver, RSA Regional Commissioner Dept. of Education, OSERS 1244 Speer Blvd, Suite 310 Denver, CO 80204-3582 Email: loerance.deaver@ed.gov Region 9 - AZ, HI, NV, GU, AS, CA, CNMI Mail to: Mr. Gilbert Williams, RSA Regional Commissioner Dept. of Education, OSERS 50 United Nations Plaza, Rm. 215 San Francisco, CA 94102 Email: gilbert.williams@ed.gov Region 10 - AK, ID, OR, WA Mail to: Mr. Richard Corbridge Dept. of Education, OSERS 915 Second Ave, Rm 2848 Seattle, WA 98174-1099 Email: richard.corbridge@ed.gov B) One (1) electronic (WORD) copy shall be sent to RSA Central Office. Send to attention of: Roslyn Thompson at email: roslyn.thompson@ed.gov If you do not have access to email, please send a copy on disk to: Attn: Roslyn Thompson Rehabilitation Services Administration 330 C Street SW, Room 3328 Washington,D.C. 20202-2741 (C) One (1) electronic (WORD) copy shall be sent to Independent Living Research Utilization at TIRR (ILRU). Send to attention of: Dawn Heinsohn at email: Heinsohn@bcm.tmc.edu If you do not have access to email, please send a copy on disk to: Dawn Heinsohn ILRU 2323 South Shepherd, Ste. 1000 Houston, TX 77019 ELECTRONIC TRANSMISSION 1) For 704 Report Part I (DSUs and SILCs) Please send electronic copies as an attached file transmitted via electronic mail to the appropriate entities listed above. To create a file for transmission, add the two letter State designator to the RSA file name e.g., Arizona's FY 2001 704 Report Part I would be identified as AZ704FY01.pt1 and would be sent to the RSA's Regional Commissioner for Region IX at gilbert.williams@ed.gov; to RSA Central Office, at roslyn.thompson@ed.gov; and to ILRU at Heinsohn@bcm.tmc.edu. 2) For 704 Report Part II (Centers for Independent Living) Please send electronic copies as an attached file transmitted via electronic mail to the appropriate entities listed above. To create a file for transmission, add the CILs name or acronym followed by "dot", followed by the two letter State designator to the RSA file name e.g., The Arizonans Building Liberty and Empowerment Center would be identified as ABLE.AZ704FY01.pt2 and the Sunshine CIL (in Arizona) would be identified as Sunshine.AZ704FY01.pt2. Electronic copies would be sent to the RSA's Regional Commissioner for Region IX at gilbert.williams@ed.gov; to RSA Central Office, at roslyn.thompson@ed.gov; and to ILRU at Heinsohn@bcm.tmc.edu. (CILs are also required to forward a copy of the 704 Report Part II to the Statewide Independent Living Council in their State.) ADDRESS LISTING In order to ensure that our files are accurate and up-to-date, we are requesting that each DSU, SILC, and CIL complete and return (with each copy of the 704 Report) the enclosed "Contact Information Form". SUBMISSION DATES The final date for submission of the 704 Report is December 31, 2001 for Section 722 States and Part C funded CILs and January 31, 2002, for Section 723 States. Should you have any further questions regarding this correspondence, please contact me at (202) 205-8292. Sincerely, Thomas E. Finch, Ph.D., Director Special Projects Division TF/Bab Enclosures OMB Control Number: 1820-0606 Expiration Date: November 30, 2003 UNITED STATES DEPARTMENT OF EDUCATION OFFICE OF SPECIAL EDUCATION AND REHABILITATION SERVICES REHABILITATION SERVICES ADMINISTRATION Instructions and Pre-Print Part I SECTION 704 ANNUAL PERFORMANCE REPORT FOR INDEPENDENT LIVING PROGRAMS CHAPTER 1 TITLE VII According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 1820-0606. The time required to complete this information collection is estimated to average 35 hours per response, including the time to review instruction, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, D.C. 20202-4651. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: Thomas E. Finch, Director, Special Projects Division, U.S. Department of Education, MES Bldg., Room 3038, 330 C St., S.W., Washington, D.C. 20202-2741 Chapter 1, Title VII of the Rehabilitation Act FREQUENTLY ASKED QUESTIONS GLOSSARY OF TERMS Instructions INSTRUCTIONS: 704 PART I SUBPART IA - ADMINISTRATIVE DATA SUBPART IAI - SOURCES AND AMOUNTS OF FUNDS AND RESOURCES SUBPART IAII - ALLOCATION OF PART B, CHAPTER 1 FUNDS SUBPART IAIII - PROVISION OF SERVICES SUBPART IAIV - GRANTS, CONTRACTS, OR OTHER ARRANGEMENTS FOR USE OF PART B FUNDS SUBPART IAV - STAFFING SUBPART IB - NUMBERS AND TYPES OF INDIVIDUALS WITH SIGNIFICANT DISABILITIES RECIVING SERVICES EITHER DIRECTLY FROM THE DSU OR THROUGH GRANTS OR CONTRACTS SUBPART IBI - CONSUMERS SERVED DURING THE REPORTING YEAR SUBPART IBII - CONSUMER CSRS CLOSED BY SEPTEMBER 30 OF THE REPORTING YEAR SUBPART IBIII - CONSUMERS (CSRS) ACTIVE ON SEPTEMBER 30 OF THE REPORTING YEAR SUBPART IBIV - CONSUMER PLANS AND WAIVERS SUBPART IBV - AGE SUBPART IBVI - GENDER SUBPART IBVII - ETHNICITY SUBPART IBVIII - RACE SUBPART IBIX - DISABILITY SUBPART IC - INDIVIDUAL AND COMMUNITY ACHIEVEMENTS AND SERVICES SUBPART ICI - INDIVIDUAL CONSUMER ACHIEVEMENTS SUBPART ICII - INDIVIDUAL SERVICES SUBPART ICIII - INDIVIDUAL CONSUMERS IN COMMUNITY-BASED LIVING SUBPART ICIV - COMMUNITY CHANGE ACHIEVEMENTS SUBPART ICV - COMMUNITY SERVICES SUBPART ID - STATEWIDE INDEPENDENT LIVING COUNCIL (SILC) REPORT SUBPART IDI - SILC'S GENERAL ACTIVITIES SUBPART IDII - SILC'S DESIGN FOR NETWORK OF CENTERS SUBPART IDIII - MONITORING AND EVALUATION IMPLEMENTATION OF THE SPIL BY THE SILC SUBPART IDIV - CONSUMER SATISFACTION SUBPART IDV - SILC COMPOSITION SUBPART IDVI - LEGAL STATUS AND PLACEMENT OF SILC SUBPART IDVII - TRAINING AND TECHNICAL ASSISTANCE NEEDS FOR NEXT FISCAL YEAR SUBPART IE - DSU(S) ACTIVITIES SUBPART IEI - COLLABORATIVE EFFORTS SUBPART IEII - EVALUATIONS CONDUCTED BY DSU(S) SUBPART IEIII - MONITORING SUBPART IF - NARRATIVE COMPARING DSU AND SILC ACTIVITIES OF THE REPORTING YEAR WITH PRIOR YEAR ACTIVITIES SUBPART IFI - COMPARATIVE NARRATIVE SUBPART IFII - SIGNIFICANT ACTIVITIES SUBPART IFIII - SUBSTANTIAL PROBLEMS SUBPART IFIV - ADDITIONAL INFORMATION RSA DIRECTORY REGIONS CENTRAL OFFICE Reporting Instrument COVER PAGE SUBPART IA - ADMINISTRATIVE DATA SUBPART IAI - SOURCES AND AMOUNTS OF FUNDS AND RESOURCES SUBPART IAII - ALLOCATION OF PART B, CHAPTER 1 FUNDS SUBPART IAIII - PROVISION OF SERVICES SUBPART IAIV - GRANTS, CONTRACTS, OR OTHER ARRANGEMENTS FOR USE OF PART B FUNDS SUBPART IAV - STAFFING SUBPART IB - NUMBERS AND TYPES OF INDIVIDUALS WITH SIGNIFICANT DISABILITIES RECIVING SERVICES EITHER DIRECTLY FROM THE DSU OR THROUGH GRANTS OR CONTRACTS SUBPART IBI - CONSUMERS SERVED DURING THE REPORTING YEAR SUBPART IBII - CONSUMER CSRS CLOSED BY SEPTEMBER 30 OF THE REPORTING YEAR SUBPART IBIII - CONSUMER CSRS ACTIVE ON SEPTEMBER 30 OF THE REPORTING YEAR SUBPART IBIV - CONSUMER PLANS AND WAIVERS SUBPART IBV - AGE SUBPART IBVI - GENDER SUBPART IBVII - ETHNICITY SUBPART IBVIII - RACE SUBPART IBIX - DISABILITY SUBPART IC - INDIVIDUAL AND COMMUNITY ACHIEVEMENTS AND SERVICES SUBPART ICI - INDIVIDUAL CONSUMER ACHIEVEMENTS SUBPART ICII - INDIVIDUAL SERVICES SUBPART ICIII - INDIVIDUAL CONSUMERS IN COMMUNITY BASED-LIVING SUBPART ICIV - COMMUNITY CHANGE ACHIEVEMENTS SUBPART ICV - COMMUNITY SERVICES SUBPART ID - STATEWIDE INDEPENDENT LIVING COUNCIL (SILC) REPORT SUBPART IDI - SILC'S GENERAL ACTIVITIES SUBPART IDII - SILC'S DESIGN FOR NETWORK OF CENTERS SUBPART IDIII - MONITORING AND EVALUATION IMPLEMENTATION OF THE SPIL BY THE SILC SUBPART IDIV - CONSUMER SATISFACTION SUBPART IDV - SILC COMPOSITION SUBPART IDVI - LEGAL STATUS AND PLACEMENT OF SILC SUBPART IDVII - TRAINING AND TECHNICAL ASSISTANCE NEEDS FOR NEXT FISCAL YEAR SUBPART IE - DSU(S) ACTIVITIES SUBPART IEI - COLLABORATIVE EFFORTS SUBPART IEII - EVALUATIONS CONDUCTED BY DSU(S) SUBPART IEIII - MONITORING SUBPART IF - NARRATIVE COMPARING DSU AND SILC ACTIVITIES FOR THE REPORTING YEAR WITH PRIOR YEAR ACTIVITIES SUBPART IFI - COMPARATIVE NARRATIVE SUBPART IFII - SIGNIFICANT ACTIVITIES SUBPART IFIII - SUBSTANTIAL PROBLEMS SUBPART IFIV - ADDITIONAL INFORMATION SIGNATURES, PRINTED NAME, TITLE, PHONE NUMBERS REPORT SUBMISSION INFORMATION Frequently Asked Questions Question: WHAT IS THE PURPOSE OF 704 PART I REPORT? Answer: The purpose of this report is to: (A) Serve as a performance activity measuring instrument of independent living (IL) programs including both quantitative and qualitative information. (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) Assure CIL compliance with the standards, assurances, and indicators of compliance with the standards in Section 725 of the Act and 34 CFR 366. (D) Collect information necessary for issuance of continuation awards for qualified CILs funded under the CIL program. (E) Collect the data required by Section 13, 706, 721, and 725 of the Act for the State Independent Living Services (SILS) and the Centers for Independent Living (CIL) programs. (F) Serve as the basis for on-site reviews of the Chapter I, Title VII of the Act grantees. (G) Obtain a report on SILC and DSU activities. (H) Establish a uniform reporting system to compile an accurate national report on independent living. (I) Serve as the State's official request for continued funding under Part B or Part C of Chapter 1 of Title VII of the Act. (J) Enable each State to access information on all funds expended for IL in the State, individuals served, services provided, products purchased, and to enable RSA to compare the performance of each State and CIL with other States and CILs. (Authority: Section 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, and 366). Question: WHAT ARE THE DEFINITIONS OF CERTAIN PHRASES AND TERMS? Answer: Listed below is an extensive Glossary of Phrases and Terms: Glossary of Terms Act The Rehabilitation Act of 1973, as amended. CIL A Center for Independent Living meeting the definition in Section 702 of the Act, and the standards in Section 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 service(s) under the program, other than information and referral. Core Services IL services defined in Section 6(17) of the Act means: information and referral services; 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. In cases 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 Section 101(a)(2)(B) of the Act, to jointly with the Statewide Independent Living Council (SILC) develop and sign the State plan for Ch.1 of Title VII under Section 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 States, 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 receiving, accounting for, and disbursing the funds for the CIL program is always the general agency. Earmarked Funds Funds appropriated by the State and expressly or clearly identified as State expenditures in the relevant fiscal year for the sole purpose of funding the general operation of CILs meeting the requirements of Sections 702 and 725 of the Act. FTE The equivalent of one person working full-time for one year. 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 Alaskan Natives, American Indians, Asian Americans, Black (African Groups) Americans, Hispanic or Latino Americans, Native Hawaiians, and Pacific Islanders. Pass Through Funds that a provider receives on behalf of a consumer that are subsequently issued by the provider directly to the consumer (e.g., representative payee funds, Medicaid or State PAS funds). Reporting Year The most recently completed Federal fiscal project year starting October 1 and ending September 30. RSA The Rehabilitation Services Administration at the United States Department of Education, Office of Special Education and Rehabilitative Services. Section 722 State A State where RSA issues grants under Part C directly to eligible agencies, i.e., CILs. Section 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. Services Provider Can mean: 1) A DSU that directly provides IL services to consumers 2) A CIL 3) An entity that provides IL services under a grant or contract; and is delegated responsibility for the determination of eligibility for IL services. SILC The Statewide Independent Living Council established in each State as required by Sections 704 and 705 of the Act. SILS A State Independent Living Services program funded under Part B, Chapter 1 of Title VII of the Act. SPIL A State Plan of Independent Living jointly developed and signed by the director of the designated State unit; and the chairperson of the Statewide Independent Living Council, acting on behalf of and at the direction of the Council. The plan shall ensure the existence of appropriate planning, financial support and coordination, and other assistance to appropriately address, on a statewide and comprehensive basis, needs in the State for: (A) The provision of State IL services (B) The development and support of a statewide network of centers for independent living (C) Working relationships between programs providing IL services, CILs, the State VR program, and other programs providing services for individuals with disabilities. State The term State includes, in addition to each of the several States of the United States, the District of Columbia, the Commonwealth of Puerto Rico, the United States Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands, except where otherwise noted. Question: WHAT IS THE STRUCTURE OF THE ANNUAL 704 REPORT? Answer: The 704 Report is composed of Part I and Part II Part I contains reports of the SILC's and DSU's activities for the reporting year. It also contains data from consumer service records when 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, work plans for the next year, and data from consumer service records maintained by the CIL. It also contains any necessary budget amendments for the next fiscal year. Activities and plans regarding the current Federal fiscal year are not typically discussed in Part II. The subpart structure of Part I is as follows: Subpart IA - Administrative Data: A report on resources received and expended during the reporting year. Subpart IB - Numbers and Types of Individuals with Significant Disabilities Receiving Services Either Directly from the DSU or Through Grants or Contracts: Provides information from CSRs on the numbers and types of consumers receiving IL services. Subpart IC - Individual and Community Achievements and Services: A report of how much, the type, and overall community work and the results of such work. This subpart should reflect the community and individual IL services provided. Subpart ID - Statewide Independent Living Council Report: A report on the activities, composition, and functions of the Statewide Independent Living Council (including the SILC survey of its technical assistance and training needs for next fiscal year). Subpart IE - DSU(s) Activities: A report on the activities of the DSU. Subpart IF - Narrative Comparing Reporting Year Activities to Prior Year Activities: A report comparing reporting year activities with prior year activities including program accomplishments and goal achievements, substantial problems or difficulties, and significant activities. Question: WHO MUST COMPLETE THE 704 PART I REPORT? Answer: Each DSU and SILC will jointly complete Part I. The SILC and the DSU must be given the freedom to independently prepare the portions of the report for which they are responsible. Subpart IF is designed to be a cooperative venture of all parties (DSU and SILC) preparing the 704 Part I report. In this manner, a complete report of activities that is jointly developed and shared within the State is assured. Only a single Part I report, with data aggregate from the State's reporting entities will be accepted by RSA. Subparts IB and ICII report information from CSRs. The DSU reports in Part I only information from CSRs maintained by a service provider other than a CIL reporting in Part II. Question: WHERE MUST THE 704 REPORT BE SUBMITTED? Answer: Reports are submitted to your RSA Regional Office. In Section 722 States the DSU and the SILC will jointly submit Part I to RSA Regional Offices. CILs funded solely with Part B or State funds will submit their Part II reports to the DSU and the SILC. The DSU will then transmit the CIL report (other than those from CILs receiving Part C funds) to RSA with their Part I report. In Section 723 States all 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 their Part I report and attach the incoming reports from CILs for reference. The aggregate Part I will be forwarded to RSA Regional Offices. Question: WHEN MUST THE DSU SUBMIT THE 704 PART I REPORT TO RSA? Answer: Date will vary depending on whether the State is a Section 722 or 723 State. Section 722 States must submit the 704 Part I Report to RSA Regional Offices, postmarked by January 31, 2001 of the preceding Federal Fiscal Year (10/1/1999 - 9/30/2000). Section 723 States must submit the 704 Part I Report to RSA Regional Offices, postmarked by February 2, 2001 of the preceding Federal Fiscal Year (10/1/1999 - 9/30/2000). Question: HOW LONG MUST RECORDS BE RETAINED? Answer: Three Years The information provided in this report by Federal grantees is subject to confirmation at an on-site 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 three years (Authority: 34 CFR 74.53). Instructions 704 PART I Instructions: 704 Part I GENERAL INSTRUCTIONS: Please respond to each subpart of this preprint. 1) When a subpart requests a description, lists, or other non-data information, but does not apply to the DSU, SILS, CILs and/or other entities a "NOT APPLICALBE" response is appropriate. 2) When a subpart requests data or a numerical response, but does not apply to the DSU, SILC, CILs and/or other entities, enter zero, "0". Specific Instructions: Please carefully read the instructions below for Subpart IA through Subpart IF and provide the requested details. Subpart IA - Administrative DATA Subpart IAI - Sources and Amounts of Funds and Resources (704(m)(4)(D) of the Act; 34 CFR Parts 74 and 75) List amounts of all resources received by the State or CIL from sections (A-C) during the federal fiscal reporting year. Round off to the nearest dollar any funds ending with cents (i.e. $240,010.87 ® $240,011) Add lines 1-12 to get the Total Resources for section (D) Identify the total amount of "pass through" funds in section (E) Subtract section (D) from section (E) to get Net Operating Resources (F) Subpart IAII - Allocation of Part B, Chapter 1 Funds (SPIL developed under sections 704 and 713 of the Act; 34 CFR 365.20) For sections (A-H) provide requested dollar amounts for Expenditures of Part B Funds and answer "Yes" or "No" as it applies to columns titled "Services Rendered by DSU Staff" and "Services Rendered by Grant or Contract" Subpart IAIII - Provision of Services (704(e) of the Act; 34 CFR 365.20 and 365.21) Indicate "Yes" or "No" in SUBPART IAIII (A) and (B). Subpart IAIV - Grants, Contracts, or Other Arrangements for Use of Part B Funds (704(f) and 713 of the Act; 34 CFR 365.23) (A) Enter requested information as in sample chart below. For Column two, refer to categories A - H in Table IAII, page 34. Example: Grant or Contractor Use of Funds (refer to Table IAII) Part B, Chapter 1 Funds Other Federal Funds Non Federal Funds (A) XYZ Grant or ABC Contract Demonstrate ways to expand IL services $123,456.00 $789,123.00 $456,789.00 INSERT ADDITIONAL ROWS AS NEEDED Total Amounts of Grants & Contracts ************** Total $123,456.00 Total $789,123.00 Total $456.789.00 Please Note: Skip Subpart IAIV (B) if all grants and/or contracts are for services to design and implement general operation procedures of CILs. (B) If the purpose of any grants or contract is to provide IL services to individuals: (1) List each grant and/or contract and indicate who determines eligibility for services Example: Name of Grant or Contract Who Determines Eligibility for Services? "D" Contract IL Specialist 2) List each grant and/or contract and indicate where CSRs are maintained and note if the location is different from (a) where eligibility is determined; and (b) main location of grant and/or contract. Example: Name of Grant and/or Contract Where are CSRs maintained? Are CSRs maintained at a location different from where eligibility is determined? Is location housing CSRs different from the main location of the grant and/or contract? Our Local Contract At Local Contract Office NO NO (C) For grants or contracts for purposes other than services, please provide a brief narrative description of the objectives to be achieved by each agreement, nature or activities conducted during the year, and results achieved. Subpart IAV - Staffing (701, 704(m)(2) of the Act; 34 CFR 364.31) Report the total number of FTEs employed in the SILS and CIL programs administered by the DSU(s) and by service providers other than CILs reporting in 704 Part II Reports submitted to RSA. Report the total decision making and other staff, the number of FTEs filled by individuals with disabilities, and the number of minority FTEs who are employed. To compute FTEs, determine the number of hours (excluding overtime) for which all employees were actually paid during the last six months of the reporting year. Multiply the hours worked by 2 (two), divide by 2080 (approximate number of hours worked by an FTE), the subsequent total is the equivalent fraction of the FTEs. Subpart IB - Numbers and types of individuals with significant disabilities reciving services either directly from the DSU or through grants or contracts (Section 13, 704(m)(B) and (D); 34 CFR 364.53) Subpart IBI - Consumers Served During the Reporting Year Include Active Consumer Service Records (CSRs) for all consumers served during the year. (A) Enter the number of active CSRs carried over from September 30 of the preceding year. (B) Enter the number of new CSRs initiated since October 1 of the reporting year. (C) Enter the total number of consumers served during the year. (A) + (B) = (C) Subpart IBII - Consumer CSRs Closed by September 30 of the Reporting Year Include in this count of consumer records those that have been purged from the active CSR files because the individual has: (A) Moved (B) Withdrew/stated that he or she had no further interest in the program (C) Died (D) Completed all goals set (E) For any reason is no longer an active consumer (F) Use this formula to derive at the total number of closed CSRs: (A) +(B) + (C) + (D) + (E) = (F) Subpart IBIII - Consumer CSRs Active on September 30 of the Reporting Year Use this formula to derive at the total number of consumers remaining active on September 30 of the reporting year: Subpart IBI (C) - Subpart IBII (F) = Subpart IBIII Please note - For the remaining sections of Subpart IB, RSA intends that the demographic information includes ALL consumers served during the year. Subpart IBIV - Consumer Plans and Waivers For the total number of consumers served during the reporting year, indicate: (A) The number of individuals who signed a waiver (B) The number of individuals with whom an ILP was developed Subpart IBV - Age Enter the number of consumers served in each age category. Subpart IBVI - Gender Enter the number of males and females served during the reporting year. Please note - the race and ethnicity categories below reflect the standards announced in OMB's decision (10/30/97 Fed. Reg.): Federal programs, as soon as possible but no later than 2003, should adopt these standards. Subpart IBVII - Ethnicity (Select one) Enter total number served for categories below: (A) Hispanic or Latino (B) Not Hispanic or Latino Subpart IBVIII - Race (Choose one or more) Enter a count of individuals based on self-identification. (A) American Indian or Alaska Native - A person having origins in any of the original peoples of North America and who maintains cultural identification through affiliation or community identification. (B) Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian subcontinent. (C) Black or African American - A person having origins in any of the Black racial groups of Africa. (D) Hispanic or Latino - A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture origin. (E) Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii or other Pacific Islands, and who maintains cultural identification through affiliation or community identification. (F) White - A person having origins in any of the original peoples of Europe, North Africa, or the Middle East. Subpart IBIX - Disability Enter a count of individuals in each category at the end of the reporting year. (These categories are meant to describe the functional limitations involved with the disability rather than a grouping of specific diagnoses of disability.) Subpart IC - Individual and Community Achievements and Services Report the total number of goals set by consumers and the number of goals met by consumers during the reporting year. The consumer is the individual who determines whether or not a goal is met. Please classify goals in the following categories: Subpart ICI - Individual Consumer Achievements (A) Self-Advocacy/Self-Empowerment - Goals involving either improvement in a consumer's ability to represent himself/herself with public and/or private entities or ability to make key decisions involving himself/herself. (B) Communication - Goals involving either improvement in a consumer's ability to understand communication by others (receptive skills), and/or improvement in a consumer's ability to share communication with others (expressive skills). (C) Mobility/Transportation - Goals to improve a consumer's access to her/his life space, environment, and community. This may occur by improving the consumer's ability to move, travel, transport himself/herself, or use public transportation. (D) Community Services - Goals that provide for a change in living situations with increased autonomy for the consumer. This may involve a consumer's goals related to obtaining/modifying an apartment or house. (E) Educational - Goals of an academic or training nature that are expected to improve the consumer's basic knowledge or increase her/his ability to perform certain skills deemed to increase her/his independence consistent with IL philosophy. (F) Vocational - IL goals related to obtaining, maintaining, or advancing in employment. (G) Self-Care - Goals to improve/maintain a consumer's autonomy with respect to activities of daily living such as personal grooming and cleaning, toileting, meal preparation, shopping, eating, etc. (H) Information Access/Technology - Goals related to a consumer obtaining and/or using a computer or other assistive technology, devices, or equipment, also a consumer's goal of developing skills in using information technology, e.g., emerging computer screen-reading software. (I) Personal Resource Management - Goals related to a consumer learning to establish and maintain a personal/family budget, managing a checkbook, and/or obtaining knowledge of available direct and in-direct resources related to income, housing, food, medical, and/or other benefits. (J) Other - IL goals not included in the above categories. Subpart ICII - Individual Services List the number of consumers receiving each of the following services during the reporting year. The total of these numbers is not expected to equal the number of consumers served, as a consumer may receive several different services during the reporting year. However, a single individual should be counted only once for each service received during the reporting year. Individuals included in this section have CSRs (except individuals receiving only information and referral [I&R] services need not have CSRs). I&R services may be provided to anyone with the sole record being the number of individuals provided I&R services. (A) Advocacy/Legal Services - Assistance and /or representation in obtaining access to benefits, services, and programs to which a consumer may be entitled. (B) Assistive Devices/Equipment Services - Provision of specialized devices and equipment such as TDDs, wheelchairs and lifts, or the provision of assistance to obtain these devices and equipment from other sources. (C) Children's Services - The provision of specific IL services designed to serve individuals with significant disabilities under the age of six. (D) Communication Services - Services directed to enable consumers to better communicate such as: interpreter services, training in communication equipment use, Braille instruction, and reading services. (E) Counseling and Related Services - These include information sharing, psychological services of a non-psychiatric, non-therapeutic nature, parent-to-parent services, and related services. (F) Family Services - Services provided to the family members of an individual with a significant disability when necessary for improving the individual's ability to live and function more independently, or 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, Home Modifications, and Shelter Services - These services are 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 individual for a period not to exceed eight weeks during any six-month period. (H) IL Skills Training and Life Skill Training Services - These may include instruction to develop independent living skills in areas such as personal care, coping, financial management, social skills, and household management. This may also include education and training necessary for living in the community and participating in community activities. (I) Information and Referral Services - Identify all individuals who requested this type of assistance. Some entities record this service using strokes on an answering pad without opening a CSR, others create a CSR or other such file for future contact and outreach. This is the only service (other then services to family members) that my be provided to all individuals, whether or not the individual has a disability. (J) Mental Restoration Services - Psychiatric restoration services including maintenance on psychotropic medication, psychological services, and treatment management for substance abuse. (K) Mobility Training Services - A variety of services involving assisting consumers to get around their homes and communities. (L) Peer Counseling Services - Counseling, teaching, information sharing, and similar kinds of contact provided to consumers by other people with disabilities. (M) Personal Assistance Services - These include, but are not limited to, assistance with personal bodily functions; communicative, household, mobility, work, emotional, cognitive, personal, and financial affairs; community participation; parenting; leisure; and other related needs. (N) Physical Restoration Services - Restoration services including medical services, health maintenance, eyeglasses, and visual services. (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 - Provision of, or assistance in obtaining through other sources, an adaptive device or appliance to substitute for one or more parts of the human body. (Q) Recreational Services - Provision or identification of opportunities for the involvement of consumers in meaningful leisure time activities. These may include such things as participation in community affairs and other recreation activities that may be competitive, active, or quiet. (R) Rehabilitation Technology Services - 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, IL and/or recreation. (S) Therapeutic Treatment - Services provided by registered occupational, physical, recreational, hearing, language, or speech therapists. (T) Transportation Services - Provision of, or arrangements for, transportation. (U) Youth Services - Specific IL services designed and provided to individuals with significant disabilities, ages 6-17, and may include training to develop skills specifically designed for youth to promote self-awareness and esteem, develop advocacy and personal power skills, and the exploration of career options. (V) Vocational Services - Any services designed to achieve paid employment. (W) Other Services - Any IL services not listed above in A-V. Subpart ICIII - Individual Consumers in Community-Based Living (A) Indicate the number of consumers who received IL services in the reporting year who successfully relocated from nursing homes or other institutions to community-based living arrangements. Community-based living arrangements include apartments, privately owned housing, self-directed assisted living, or self-directed with family/friends. (B) Indicate the number of consumers for whom IL services prevented the necessity of entering nursing homes or other institutions. These consumers should have received significant IL services that enabled consumers to continue living in a community-based living arrangement. Subpart ICIV - Community Change Achievements Report the total number of goals for community change set and met. Community change has not been captured in a uniform manner in prior versions of this annual performance report. Each "Community Change Achievement" goal set/met would be expected to benefit many people and involve the use of a significant amount of resources over several months to several years to bring about the change. Goals should be broad and reflect consumer needs (for example, rather than counting curb cuts, a goal may involve implementing an education and advocacy campaign to cut curbs in a large section of a city where curb cuts either don't exist or are scattered). Annual goals of a percentage or numerical target less than 100% change may be set, e.g., establish an annual goal of increasing recreational options offered by the city and county for individuals with disabilities by 20% (or 6 new options) each year for the next 5 years. (A) Community Integration - Goals involve the establishment or operation of a program to assist consumers in relocating from nursing homes or other institutions into the community. Other goals in this category would include working with public and private entities to establish new community options or capacity to meet the needs of consumers, or revising to include people with significant disabilities in existing community options or capacities that have not previously included individuals with significant disabilities. (B) Collaboration - Goals involve the establishment of new strategic alliances through communication, cooperation, and coordination with other stakeholder entities. Goals may also include the development of new coalitions to maximize utilization of community resources or open new resource development opportunities. (C) Educational - Goals include creating or facilitating the creation of academic or training programs designed to meet the transition from school to independent living and school to work needs of individuals with significant disabilities (D) Housing Opportunities/Home Modification - Goals include creating or facilitating the creation of new community options or capacity to meet the housing needs of consumers. (CILs may not provide residence to consumers, but should work with community housing providers to ensure that consumers have affordable/accessible options to live in communities.) (E) Information Access/Technology - Goals involve creating or facilitating the creation of new community options to meet information access or technology needs of individuals with significant disabilities in the community. Goals in this category would include the establishment of a wide range of options from a program to give computers to consumers to a campaign to get all area restaurants to have Braille menus for their customers who are blind. (F) Mobility/Transportation - Goals include the establishment, or facilitating the creation of, new or substantially improved programs or services to increase consumers' access to their life space, environment, and community. Programs could include personal mobility programs for individuals who are blind or have cognitive impairments, public transit education programs designed to increase use of existing transit systems, or the creation of new consumer transportation. (G) Personal Assistant Services - Goals include the establishment or expansion of program(s) to meet the personal assistance needs of individuals with significant disabilities. (H) Physical/Attitudinal Barrier Removal - Goals include the creation or operation of programs or campaigns designed to remove community physical or attitudinal barriers to the full participation of individuals with significant disabilities in society. Please do NOT include goals listed under other categories. (I) Vocational - Goals include the establishment/inclusion of people with disabilities in programs to obtain, maintain, or advance in employment. (J) Other - Report community change goals not included in the above categories. Subpart ICV - Community Services Report the number of hours of community service provided in each of the following categories. Please round to nearest whole hour. (Please note - Report the number of hours of community service, not the number of hours times the number of participants. For Example: If you give a one-hour presentation with 50 participants, you should count one hour of community service, NOT 50 hours.) (A) Community and Systems Advocacy - Includes efforts to implement local and State policy changes to make facilities, services, and opportunities available and accessible to individuals with disabilities. (B) Outreach Efforts - Entails the location of, and encouragement to use services for unserved/underserved populations of individuals with significant disabilities. (C) Publications - Includes time spent in the creation and distribution of publications including accessibility guides, disability awareness brochures, ADA information, etc. (D) Community Education/Integration Services - Activities and information programs to enhance the community's awareness of disabilities and disability issues, e.g., local TV, radio, or newspaper campaigns. (E) Maintaining Registries/Libraries/Databases - Includes activities related to creating and maintaining directories for personal assistants, recreation opportunities, accessible transportation, accessible housing, and other support services. Includes activities related to the establishment or maintenance of libraries and/or databases to support information and referral services or consumer and staff education. (F) Collaboration/Networking - Activities related to building coalitions or collaborative partnerships designed to expand the participation of individuals with significant disabilities in community services and programs. (G) Other Services - Community activities that do not fit in any of the above definitions. (H) To derive at GRAND TOTAL HOURS add (A) through (G): (A) + (B) + (C) + (D) + (E) + (F) + (G) = (H) Subpart ID - Statewide Independent Living Council (SILC) Report (705(C)(5) of the Act; 34 CFR 364.21(g)) Subpart IDI - SILC's General Activities Please provide a concise yet detailed summary of the SILC's activities during the reporting year including: (A) Exemplary activities, major accomplishments, problems encountered and problem resolution. (B) Relations with the DSU(s), activities, successes, problems, solutions, as well as collaborative efforts for communication, coordination, and cooperation with CILs, DSUs, and other agencies and groups. (C) Allocation of resources and development of the State plan. (D) Other information that the SILC believes would be helpful or informative to RSA, the Congress, and other CILs/SILCs, and State agencies. Subpart IDII - SILC's Design for Network of Centers The SILC and the DSU should coordinate and report on: (A) The development and implementation of the design for a statewide network of CILs, with particular emphasis on: (1) Underserved and Unserved areas (2) Priorities for establishment of new centers (3) Estimated resources needed to accomplish each step of the design (B) This narrative should include a discussion of the supplemental data used to establish priorities and develop the SILC's design for a network of Centers. Subpart IDIII - Monitoring and Evaluation Implementation of the SPIL by the SILC Provide a summary of monitoring and evaluation findings, including both positive and negative findings. List any exemplary activities, particularly those the SILC considers worthy of replication, and denote any incidences of substantial deviation from the State plan. This summary should include discussions of : (A) The SILC's monitoring and evaluation activities related to implementation of the State Plan for independent living. (B) The SILC's findings and recommendations related to any problems in the implementation of the State Plan. (C) SILC participation in any on-site compliance reviews of CILs or DSU(s). (D) The SILC's involvement in the development of corrective action plans addressing deficiencies of CILs, DSU(s), deriving from on-site or other reviews, etc. (E) Activities and results related to evaluation of the effectiveness of the State plan in meeting objectives established in the Plan. Subpart IDIV - Consumer Satisfaction Provide a report on consumer satisfaction, consistent with Section 16 of the approved SPIL, for the reporting year. Subpart IDV - SILC Composition Reply as appropriate, with either a number or with "YES" or "NO" Subpart IDVI - Legal Status and Placement of SILC (Section 705(a) of the Act; 34 CFR 364.21(a)(2)) Provide a brief description of the legal status and placement of the SILC in as much as, the SILC is not established as an entity within any State agency, including the DSU, and is independent of the DSU and all other State agencies. Subpart IDVII - Training and Technical Assistance Needs for Next Fiscal Year (Section 721(b) (3) of the Act 34 CFR 366.13) Based on the SILC's review of the performance of the entities and service providers involved in the implementation and administration of the State Plan, please identify (1) the training and technical assistance needs in the State and (2) the needs of the SILC in carrying out its responsibilities. Choose up to 10 priority needs, using the boxes to the right, reflecting technical assistance and training needs. Report any comments or clarifications using the blank space at the end of the chart. The SILC may also identify training and technical assistance needs of the CILs providing services in the State, resulting from the SILC's evaluation and monitoring activities (under Section 721(b)(3) of the Act). The needs identified will be used to design CIL and SILC training opportunities offered through the training and technical assistance cooperative agreement. Subpart IE - DSU(s) Activities (704(M)(4)(D) of the Act; 34 CFR 364.22; 364.38) Subpart IEI - Collaborative Efforts Provide a summary of DSU collaboration activities including efforts for communication, coordination, and cooperation with the CILs SILC, and other agencies and groups. Subpart IEII - Evaluations Conducted by DSU(s) Provide a summary/description of: (A) Evaluations conducted by the DSU(s) (B) Any jointly conducted activities with the SILC related to implementing the evaluation plan required under 704(n) of the Act (C) Collaborative efforts with the SILC and other entities providing independent living services and conducting independent living programs Subpart IEIII - Monitoring Provide a summary of monitoring activities conducted by the DSU(s) to implement findings under the SPIL, including: (A) 723 States - Provide a summary of each CIL administered an on-site review during this reporting period, including: (1) Level of compliance (standards in section 725 of the Act) (2) Description of exemplary, replicable model practices for both CILs and DSUs (723(g) of the Act, 34 CFR 366.38). (3) Summaries of each CIL's corrective action plan developed as a result of the CIL's non-compliance status (723(h) of the Act, 34 CFR 366.39), if applicable. (B) 722 States - Provide a summary of each CIL administered an on-site review during this reporting period, including: (1) Level of compliance (standards in section 725 of the Act) (2) Description of exemplary, replicable model practices for both CILs and DSUs (3) Summaries of each CIL's corrective action plan developed as a result of the CIL's non-compliance status, if applicable. Subpart IF - Narrative Comparing DSU and SILC activities of the reporting year with prior year activities (704(m)(4)(D), 705(c)(5) of the Act; 34 CFR 366.50(I)(7) Subpart IFI - Comparative Narrative In a narrative form, compare this reporting year's program proposed objectives and achieved goals with the immediate preceding year. Subpart IFII - Significant Activities Describe replicable, noteworthy and significant activities not reported elsewhere in other subparts of this report, e.g. brief summaries of innovative practices, not reported in previous years, which could be modeled by other States and CILs. Subpart IFIII - Substantial Problems Describe any substantial problems encountered by the DSU and SILC and discuss attempted resolutions. Subpart IFIV - Additional Information List any additional information, comments, or explanations of the reporting year activities and data. Do not report information in this subpart that is included in another subpart. RSA Directory Regions: Region I Regional Commissioner: Mr. John Szufnarowski Dept. of Education, OSERS J.W. McCormack Post Office and Court House Rm 232 Boston, MA 02109 (617) 223-4086 VOICE (617) 223-4573 TDD (617) 223-4573 FAX IL Program: Richard Anderson Illeana Prancan *CT, ME, NH, RI, VT, MA Region II Regional Commissioner: Mr. John Szufnarowski Dept. of Education, OSERS 75 Park Place, Rm 1208 New York, NY 10007 (212) 264-4016 VOICE (212) 264-4028 TDD (212) 264-3029 FAX IL Program: Richard Anderson Janice Plumer *NJ, PR, VI, NY Region III Regional Commissioner: Dr. Ralph Pacinelli Dept. of Education, OSERS The Wanamaker Building Suite 512 100 Penn Square East Philadelphia, PA 19107 (215) 656-8531 VOICE (215) 656-6186 TDD (215) 656-6188 FAX IL Program: Keith Beichner Margurite Pickney *DC, DE, MD, VA, WVA, PA Region IV Regional Commissioner: Dr. Ralph Pacinelli Dept. of Education, OSERS 61 Forsyth St. SW Suite 18T91 Atlanta, GA 30303-3104 (404) 562-6330 VOICE (404) 562-6347 TDD (404) 562-6346 FAX IL Program: Sue Rankin-White Dan Hunsberger *AL, FL, KY, NC, SC, TN, GA, MS Region V Regional Commissioner: Dr. Douglas Burleigh Dept. of Education, OSERS 111 N. Canal Rm. 1048 Chicago, IL 60606 (312) 886-8630 VOICE (312) 353-9694 TDD (312) 353-8623 FAX IL Program: Zilpha Hibner Kathy Niemi *IN, MI, MN, OH, WI, IL Region VI Regional Commissioner: Mr. Loerance Deaver Dept. of Education, OSERS 1999 Bryan St. Rm. 2740 Dallas, TX 75201-6817 (214) 880-4927 VOICE (214) 880-4833 TDD (214) 880-4931 FAX IL Program: Mike McGill Loretta Thomas *AK, LA, MN, OK, TX Region VII Regional Commissioner: Dr. Douglas Burleigh Dept. of Education, OSERS 10220 N. Executive Hills Blvd Kansas City, MO 64153-1367 (816) 880-4107 VOICE (816) 891-0985 TDD (816) 891-0807 FAX IL Program: Rodney King Mari Kierstein *IA, KS, NB, MO Region VIII Regional Commissioner: Mr. Loerance Deaver Dept. of Education, OSERS FOB Suite 310 - 1244 Speer Blvd Denver, CO 80204-3582 (303) 844-2135 VOICE (303) 844-2890 TDD (303) 844-6269 FAX IL Program: Mike McGill Patty Burrows *MT, ND, SD, UT, WY, CO Region IX Regional Commissioner: Mr. Gilbert Williams Dept. of Education, OSERS FOB Rm 215 - 50 United Nations Plaza San Francisco, CA 94102 (415) 437-7840 VOICE (415) 556-3323 TDD (415) 437-7848 FAX IL Program: Gilbert Williams Gayle Palumbo *AZ, HI, NV, Gu, AS, CA, CNMI Region X Regional Commissioner: Mr. Gilbert Williams Dept. of Education, OSERS 915 Second Ave, Rm 2848 Seattle, WA 98174-1099 (206) 220-7840 VOICE (206) 220-7849 TDD (206) 220-7842 FAX IL Program: Chris Smith Diana Koreski *AK, ID, OR, WA Central Office: IL Team Leader: Mr. James Billy Division of Special Projects Rehabilitation Services Administration 330 C Street SW Rm. 3326 Washington, D.C. 20202-2741 (202) 205-9362 VOICE (202) 260-9424 FAX (202) 205-8243 TDD E-mail: james_billy@ed.gov CIL Program Officer: Ms. Brenda Bercegeay Division of Special Projects Rehabilitation Services Administration 330 C Street SW Rm. 3332 Washington, D.C. 20202-2741 (202) 205-8291 VOICE (202) 260-9424 FAX (202) 205-8243 TDD E-mail: brenda_bercegeay@ed.gov Director, Special Projects Division: Thomas E. Finch, Ph.D. Rehabilitation Services Administration 330 C Street SW Rm. 3038 Washington, D.C. 20202-2741 (202) 205-8292 VOICE (202) 260-9424 FAX (202) 205-8243 TDD E-mail: tom_finch@ed.gov Reporting Instrument OMB Control Number: 1820-0606 Expiration Date: November 30, 2003 UNITED STATES DEPARTMENT OF EDUCATION Office of Special Education and Rehabilitation Services REHABILTATION SERVICES ADMINISTRATION ANNUAL PERFORMANCE REPORT for STATE INDEPENDENT LIVING PROGRAMS Part I State Independent Living Services and The Centers for Independent Living Programs Chapter 1, Title VII of the Rehabilitation Act, as Amended FISCAL YEAR________ With Citations STATE_________________________________________GR ANT #_____________________ COUNTIES SERVED___________________________________________ __________________________ ___________________________________________________ ___________________________ Subpart IA - Administrative DATA Subpart IAI - Sources and Amounts of Funds and 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 Resources (7) Foundations, Corporation, or Trust Grants $______________ (8) Donations from Individuals $______________ (9) Membership Fees $______________ (10) Investment Income/Endowment $______________ (11) Fees for Service (program income, etc.) $______________ (12) Other resources (in-kind, fund raising, etc.) $______________ (D) Total Resources (sum of lines 1-12) $______________ (E) Amount of total resources that "pass through" to Consumers, e.g., personal assistance services funds $______________ (F) Net Operating Resources (D) - (E) = (F) $______________ * Include "pass through" funds. Subpart IAII - Allocation of Part B, Chapter 1 Funds (SPIL developed under Sections 704 and 713 of the Act: 34 CFR 365.20) What Services were Provided with Part B Funds Expenditures of Part B Funds for Services Services Rendered By DSU Staff Services Rendered By Grant or Contract (A) Funds the resource plan for the SILC $ Yes No Yes No (B) Provide IL services directly through grant or contract $ Yes No Yes No (C) Demonstrate ways to expand IL services $ Yes No Yes No (D) Support of the general operation of CILs $ Yes No Yes No (E) Support activities to increase capacity to develop approaches or systems for providing IL services $ Yes No Yes No (F) Conduct studies and analysis, gather information, develop model policies, and present information in order to enhance IL services $ Yes No Yes No (G) Training regarding IL philosophy $ Yes No Yes No (H) Provide outreach to unserved or underserved populations, including minority groups and urban and rural populations $ Yes No Yes No Subpart IAIII - Provision of Services (704(e) of the Act; 34 CFR 365.20 and 365.21) (A) Does the DSU provide community IL services using part B funds directly or though grant or contract to a service provider other than a CIL reporting in 704 Part II? _______Yes _______No (B) Does the DSU directly provide IL services to individuals with significant disabilities; directly determine eligibility for such individuals; and the CSRs for those individuals are maintained outside a CIL reporting in 704 Part II? _______Y es _______No Subpart IAIV - Grants, Contracts, or Other Arrangements for Use of Part B Funds (704(f) and 713 of the Act; 34 CFR 365.23) (A) Enter requested information in the chart below: Grant or Contractor Use of Funds (Table IAII) Part B Ch. 1 Funds Other Federal Funds Non Federal Sources Total Amount of Grants and Contracts ************ $ $ $ (B) If the purpose of any grant or contract is to provide IL services to individuals: (1) List each grant and/or contract and indicate where eligibility for services is determined Name of Grant or Contract Who Determines Eligibility for Services? (2) List each grant and/or contract and indicate where CSRs are maintained and note if the location is different from (a) where eligibility is determined; and (b) main location of grant and/or contract Name of Grant and/or Contract Where are CSRs maintained? Are CSRs maintained at a location different from where eligibility is determined? Is location housing CSRs different from the main location of the grant and/or contract? (C) For grants or contracts for purposes other than services, please provide a brief narrative description of the objectives for each agreement, what activities were conducted during the year, and what results were achieved. Subpart IAV - Staffing Enter requested staff information in the chart below: SILS CILs Program Total Number of FTEs Total Number of Persons with Disabilities Total Number of Persons Who are Minorities Decision Making Staff Other Staff Subpart IB - Numbers and types of individuals with significant disabilities reciving services either directly from the DSU or through grants or contracts (Section 13, 704(m)(B) and (D); 34 CFR 364.53) Subpart IBI - Consumers Served During the Reporting Year (A) CSRs carried from previous year __________ (B) CSRs started since Oct. 1 of the reporting year __________ (C) Total consumers served: (A) + (B) =(C) __________ Subpart IBII - Consumer CSRs Closed by September 30 of the Reporting Year (A) Moved __________ (B) Withdrew __________ (C) Died __________ (D) Completed all goals set __________ (E) Other __________ (F) Total Closed CSRs: (A) + (B) + (C) + (D) + (E) = (F) __________ Subpart IBIII - Consumer CSRs Active on September 30 of the Reporting Year Subpart IBI (C) - Subpart IBII (F) = Subpart IBIII __________ Subpart IBIV - Consumer Plans and Waivers (A) Number of individuals who signed a waiver __________ (B) Number of individuals with whom an ILP was developed __________ Subpart IBV - Age (A) Under 6 __________ (B) 6 - 17 __________ (C) 18 - 22 __________ (D) 23 - 64 __________ (E) 65 & Over __________ (F) Unknown __________ Subpart IBVI - Gender (A) Female __________ (B) Male __________ Subpart IBVII - Ethnicity (Select one) (A) Hispanic or Latino __________ (B) Not Hispanic or Latino __________ Subpart IBVIII - Race (Choose one or more) (A) American Indian or Alaska Native __________ (B) Asian __________ (C) Black or African American __________ (D) Hispanic or Latino __________ (E) Native Hawaiian or Other Pacific Islander __________ (F) White __________ Subpart IBIX - Disability (A) Cognitive __________ (B) Mental/Emotional __________ (C) Physical __________ (D) Hearing __________ (E) Vision __________ (F) Multiple Disability __________ (G) Other __________ Subpart IC - Individual and Community Achievements and Services Subpart ICI - Individual Consumer Achievements Goals Set Goals Met (A) Self-Advocacy/Self-Empowerment __________ __________ (B) Communication __________ __________ (C) Mobility/Transportation __________ __________ (D) Community Services __________ __________ (E) Educational __________ __________ (F) Vocational __________ __________ (G) Self-Care __________ __________ (H) Information Access/Technology __________ __________ (I) Personal Resource Management __________ __________ (J) Other __________ __________ Subpart ICII - Individual Services (A) Advocacy/Legal Services __________ (B) Assistive Devices/Equipment Services __________ (C) Children's Services __________ (D) Communication Services __________ (E) Counseling and Related Services __________ (F) Family Services __________ (G) Housing, Home Modifications, and Shelter Services __________ (H) IL Skills Training and Life Skills Training Services __________ (I) Information and Referral Services __________ (J) Mental Restoration Services __________ (K) Mobility Training Services __________ (L) Peer Counseling Services __________ (M) Personal Assistance Services __________ (N) Physical Restoration Services __________ (O) Preventive Services __________ (P) Prostheses and Other Appliances __________ (Q) Recreational Services __________ (R) Rehabilitation Technology Services __________ (S) Therapeutic Treatment __________ (T) Transportation Services __________ (U) Youth Services __________ (V) Vocational Services __________ (W) Other Services __________ Subpart ICIII - Individual Consumers in Community Based-Living (A) How many individuals were successfully relocated from nursing homes or other institutions to community-based living arrangements? __________ (B) How many individuals for whom IL services prevented the necessity of entering nursing homes or other institutions and therefore continued living in community-based living arrangement? __________ Subpart ICIV - Community Change Achievements Goals Set Goals Met (A) Community Integration __________ __________ (B) Collaboration __________ __________ (C) Educational __________ __________ (D) Housing Opportunities/Home Modification __________ __________ (E) Information Access/Technology __________ __________ (F) Mobility/Transportation __________ __________ (G) Personal Assistant Services __________ __________ (H) Physical/Attitudinal Barrier Removal __________ __________ (I) Vocational __________ __________ (J) Other __________ __________ Subpart ICV - Community Services (A) Community and Systems Advocacy __________ (B) Outreach Efforts __________ (C) Publications __________ (D) Community Education/Integration Services __________ (E) Maintaining Registries/Libraries/Databases __________ (F) Collaboration/Networking __________ (G) Other Services __________ (H) Grand Total Hours [Add (A) through(G)] __________ Subpart ID - Statewide Independent Living Council (SILC) Report (705(C)(5) of the Act; 34 CFR 364.21(g)) Subpart IDI - SILC's General Activities In the space provided below, provide a summary of SILC activities during the reporting year (refer to Subpart IDI instructions page 25). Additional space and/or pages may be added as needed. Subpart IDII - SILC's Design for Network of Centers In the space below, discuss the SILC's plan for development and implementation of a statewide network of CILs (refer to Subpart IDII instructions page 26). Additional space and/or pages may be added as needed. Subpart IDIII - Monitoring and Evaluation Implementation of the SPIL by the SILC Provide a summary of SPIL evaluation findings (refer to Subpart IDIII instructions page 26). Additional space and/or pages may be added as needed. Subpart IDIV - Consumer Satisfaction Provide a summary of consumer satisfaction findings (refer to Subpart IDIV instructions page 26). Additional space and/or pages may be added as needed. Subpart IDV - SILC Composition Complete the following chart: SILC Composition Questions: Reply: (A) What is the total number of persons on the SILC? (B) How many SILC members have disabilities, as defined in 34 CFR 364.4(b), and are not employed by a State agency or a CIL? (C) Is a representative of the DSU an ex-Officio member of the SILC? (D) How many voting members are on the SILC? (E) State the number of different disability groups (physical, mental, cognitive, hearing, vision, or multiple) represented by members of the SILC. F) Is a CIL director chosen by CIL directors within the State appointed to the SILC? (G) Does the SILC include representatives from other State agencies that provide services for individuals with disabilities? (H) Does the SILC have a voting membership that is knowledgeable about CILs and IL services? (I) Do SILC members provide statewide representation? (J) Is the SILC Chairperson elected from among the voting members of the SILC pursuant to section 705(b)(5) of the Act? (K) Are there one or more section 121 projects in the State? (L) If (K) above is answered "yes", does the SILC include at least one representative from the directors of the section 121 projects? Subpart IDVI - Legal Status and Placement of SILC In the space below provide a brief description of the legal status and placement of the SILC (refer to Subpart IDVI instructions page 27). Additional space and/or pages may be added as need. Subpart IDVII - Training and Technical Assistance Needs for Next Fiscal Year Training and Technical Assistance Needs Choose up to 10 Priority Needs --- Rate items 1-10 with 1 being most important Advocacy/Leadership Development General Overview Community/Grassroots Organizing Individual Empowerment Systems Advocacy Legislative Process Applicable Laws General overview and promulgation of various disability laws Americans with Disabilities Act Air-Carrier's Access Act Fair Housing Act Individuals with Disabilities Education Act Medicaid/Medicare/PAS/waivers/long-term care Rehabilitation Act of 1973, as amended Social Security Act Workforce Investment Act of 1998 Ticket to Work and Work Incentives Improvement Act of 1999 Assistive Technologies General Overview Data Collecting and Reporting General Overview 704 Reports Dual Reporting Requirements Case Documentation Disability Awareness and Information Specific Issues Evaluation General Overview CIL Standards and Indicators Community Needs Assessment Consumer Satisfaction Surveys Focus Groups Government Performance Results Act and Title VII Outcome Measures Financial: Grant Management General Overview Federal Regulations Budgeting Fund Accounting Financial: Resource Development General Overview Diversification of Funding Base Fee-for-Service Approaches For Profit Subsidiaries Fund-Raising Events of Statewide Campaigns Grant Writing Independent Living Philosophy General Overview Innovative Programs Best Practices Specific Examples Management Information Systems Computer Skills Software Marketing and Public Relations General Overview Presentation/Workshop Skills Community Awareness Networking Strategies General Overview Electronic Among CILs & SILCs Community Partners Program Planning General Overview of Program Management and Staff Development CIL Executive Directorship Skills Building Conflict Management and Alternative Dispute Resolution First-Line CIL Supervisor Skills Building IL Skills Modules Peer Mentoring Program Design Time Management Team Building Outreach to Unserved/Underserved Populations General Overview Disability Minority "Potential" Consumers Who are Institutionalized Rural Urban SILC Roles/Relationship to CILs General Overview Development of State Plan for Independent Living Implementation (monitor & review) of SPIL Public Meetings Role and Responsibilities of Executive Board Role and Responsibilities of General Members Collaborations with In-State Stakeholders Volunteer Programs General Overview Optional Areas and/or Comments (write-in) Subpart IE - DSU(s) Activities (704(M)(4)(D) of the Act; 34 CFR 364.22; 364.38) Subpart IEI - Collaborative Efforts In the space below, discuss DSU collaborative efforts (refer to Subpart IEI instructions page 27). Additional space and/or pages may be added as needed. Subpart IEII - Evaluations Conducted by DSU(s) In the space below, provide a summary of evaluations conducted by the DSU(s) (refer to Subpart IEII instructions page 27). Additional space and/or pages may be added as needed. Subpart IEIII - Monitoring In the space below, provide a summary of monitoring activities conducted by the DSU(s) (refer to Subpart IEIII instructions page 28). Additional space and/or pages may be added as needed. Subpart IF - Narrative comparing dsu and silc activities for the reporting year with prior year activities (704(m)(4)(D), 705(c)(5) of the Act; 34 CFR 366.50(I)(7) Subpart IFI - Comparative Narrative Denote in a comparative narrative this reporting year's program proposed objectives and achieved goals with the immediate preceding year. Subpart IFII - Significant Activities In the space below describe significant activities (refer to Subpart IFII instruction page 29). Additional space and/or pages may be added as needed. Subpart IFIII - Substantial Problems In the space below, describe problems encountered and attempted resolutions (refer to Subpart IFIII instructions page 29). Additional space and/or pages may be added as needed. Subpart IFIV - Additional Information In the space below, list any additional information, comments, or explanations of the reporting year activities and data compared to the previous year. Signatures, Printed name, Title, phone Numbers Please sign and print your name, title and your phone number. 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 NUMBER Report Submission Information Please Mail: (A) One (1) hard copy and One (1) electronic copy - To RSA Regional Office. The hard copy will serve as the official copy of the 704 Report. If you do not have access to email, please provide your electronic copy on disk. (See transmittal letter for contact information.) (B) One (1) Electronic copy - To RSA Central Office. If you do not have access to email, please provide your electronic copy on disk. Send to attention of: Roslyn Thompson at email: roslyn_thompson@ed.gov -or- Attn: Roslyn Thompson 330 C Street, SW Rm. 3328 Washington, D.C. 20202-2741 (C) One (1) Electronic copy - To Independent Living Research Utilization at TIRR. Send to: Dawn Heinsohn at email: Heinsohn@bcm.tmc.edu -or- Attn: Dawn Heinsohn ILRU 2323 South Shepherd, Ste. 1000 Houston, TX 77019 Due Dates: For 722 States - Copies must be sent no later than January 31, 2001. For 723 State - Copies must be sent no later than February 28, 2001. OMB Control Number: 1820-0606 Expiration Date: November 30, 2003 UNITED STATES DEPARTMENT OF EDUCATION OFFICE OF SPECIAL EDUCATION AND REHABILITATION SERVICES REHABILITATION SERVICES ADMINISTRATION Instructions and Pre-Print Part II SECTION 704 ANNUAL PERFORMANCE REPORT FOR CENTERS FOR INDEPENDENT LIVING According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 1820-0606. The time required to complete this information collection is estimated to average 35 hours per response, including the time to review instruction, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, D.C. 20202-4651. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: Thomas E. Finch, Director, Special Projects Division, U.S. Department of Education, MES Bldg., Room 3038, 330 C St., S.W., Washington, D.C. 20202-2741 Chapter 1, Title VII of the Rehabilitation Act Frequently Asked Questions GLOSSARY OF TERMS INSTRUCTIONS Instructions: 704 Part II Subpart IIA - Administrative DATA SUBPART IIAI - SOURCES AND AMOUNTS OF FUNDS AND RESOURCES Subpart IIB - Numbers and types of individuals with significant disabilities reciving services either directly from the CIL or through grants or contracts SUBPART IIBI - CONSUMERS SERVED DURING THE REPORTING YEAR SUBPART IIBII - CONSUMER CSRS CLOSED BY SEPTEMBER 30 OF THE REPORTING YEAR SUBPART IIBIII - CONSUMER CSRS ACTIVE ON SEPTEMBER 30 OF THE REPORTING YEAR SUBPART IIBIV - CONSUMER PLANS AND WAIVERS SUBPART IIBV - AGE SUBPART IIBVI - GENDER SUBPART IIBVII - ETHNICITY SUBPART IIBVIII - RACE SUBPART IIBIX - DISABILITY Subpart IIC - Individual and Community Achievements and Services SUBPART IICI - INDIVIDUAL CONSUMER ACHIEVEMENTS SUBPART IICII - INDIVIDUAL SERVICES SUBPART IICIII - INDIVIDUAL CONSUMERS IN COMMUNITY-BASED LIVING SUBPART IICIV - COMMUNITY CHANGE ACHIEVEMENTS SUBPART IICV - COMMUNITY SERVICES Subpart IID - applicant self evaluation based on the six compiance indicators Subpart IIE - Comparison of Program Activities with the reporting year work plan and with the planned activities in the year immediately preceding the reporting year Subpart IIf - Next Year's Plans SUBPART IIFI - NARRATIVE SUBPART IIFII - TRAINING AND TECHNICAL ASSISTANCE NEEDS FOR THE NEXT FISCAL YEAR Subpart IIG - Budget Summary RSA Directory REGIONS CENTRAL OFFICE REPORTING INSTRUMENT Cover Sheet Subpart IIA - Administrative DAta SUBPART IIAI - SOURCES AND AMOUNTS OF FUNDS AND RESOURCES Subpart IIB - Numbers and types of individuals with significant disabilities reciving services either directly from the DSU or through grants or contracts SUBPART IIBI - CONSUMERS SERVED DURING THE REPORTING YEAR SUBPART IIBII - CONSUMER CSRS CLOSED BY SEPTEMBER 30 OF THE REPORTING YEAR SUBPART IIBIII - CONSUMER CSRS ACTIVE ON SEPTEMBER 30 OF THE REPORTING YEAR SUBPART IIBIV - CONSUMER PLANS AND WAIVERS SUBPART IIBV - AGE SUBPART IIBVI - GENDER SUBPART IIBVII - ETHNICITY (SELECT ONE) SUBPART IIBVIII - RACE SUBPART IIBIX - DISABILITY Subpart IIC - Individual and Community Achievements and Services SUBPART IICI - INDIVIDUAL CONSUMER ACHIEVEMENTS SUBPART IICII - INDIVIDUAL SERVICES SUBPART IICIII - INDIVIDUAL CONSUMERS IN COMMUNITY BASED-LIVING SUBPART IICIV - COMMUNITY CHANGE ACHIEVEMENTS SUBPART IICV - COMMUNITY SERVICES Subpart IID - Applicant Self-Evaluation based on the Six Compliance Indicators SUBPART IIDI - COMPLIANCE INDICATOR 1: PHILOSOPHY SUBPART IIDII - COMPLIANCE INDICATOR 2: PROVISION OF SERVICES ON A CROSS-DISABILITY BASIS SUBPART IIDIII - COMPLIANCE INDICATOR 3: INDEPENDENT LIVING GOALS SUBPART IIDIV - COMPLIANCE INDICATOR 4: COMMUNITY OPTIONS AND COMMUNITY CAPACITY SUBPART IIDV - COMPLIANCE INDICATOR 5: IL CORE SERVICES AND OTHER IL SERVICES SUBPART IIDVI - COMPLIANCE INDICATOR 6: RESOURCE DEVELOPMENT ACTIVITIES Subpart IIE - Comparison of Program Activities with the reporting year work plan and with the planned activities in the year immediately preceding the reporting year Subpart IIf - Next Year's Plans SUBPART IIFI - NARRATIVE SUBPART IIFII - TRAINING AND TECHNICAL ASSISTANCE NEEDS FOR THE NEXT FISCAL YEAR subpart IIG - Budget Summary Signatures, Printed name, Title, phone Numbers Report Submission Information Frequently Asked Questions QUESTION: What is the Purpose of 704 Part II Report? ANSWER: The purpose of this report is to: (A) Serve as a performance activity measuring instrument of independent living (il) programs including both quantitative and qualitative information. (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) Assure cil compliance with the standards, assurances, and indicators of compliance with the standards in section 725 of the act and 34 cfr 366. (D) Collect information necessary for issuance of continuation awards for qualified cils funded under the cil program. (E) Collect the data required by section 13, 706, 721, and 725 of the act for the state independent living services (sils) and the centers for independent living (cil) programs. (F) Serve as the basis for on-site reviews of the chapter i, title vii of the act grantees. (G) Establish a uniform reporting system to compile an accurate national report on independent living. (H) Enable each state to access information on all funds expended for il in the state, individuals served, services provided, products purchased, and to enable rsa to compare the performance of each state and cil with other states and cils. (authority: section 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, and 366). Question: What are the definitions of certain phrases and terms? Answer: Listed below is an extensive glossary of phrases and terms: Glossary of Terms Act The Rehabilitation Act of 1973, as amended. CIL A Center for Independent Living meeting the definition in section 702 of the act, and the standards in section 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 service(s) under the program, other than information and referral. CORE SERVICES IL services defined in section 6(17) of the act means; information and referral services; 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. In cases 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 section 101(a)(2)(b) of the act, to jointly with the statewide independent living council (SILC) develop and sign the state plan for ch.1 of title vii under section 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 states, 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 receiving, accounting for, and disbursing the funds for the CIL program is always the general agency. Earmarked Funds Funds appropriated by the State and expressly or clearly identified as State expenditures in the relevant fiscal year for the sole purpose of funding the general operation of CILs meeting the requirements of Sections 702 and 725 of the Act. FTE The equivalent of one person working full-time for one year. 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 Alaskan Natives, American Indians, Asian Americans, Black (African Groups) Americans, Hispanic Or Latino Americans, Native Hawaiians, And Pacific Islanders. PASS THROUGH Funds that a provider receives on behalf of a consumer that are subsequently issued by the provider directly to the consumer (e.g., representative payee funds, Medicaid or state pas funds). REPORTING YEAR The most recently completed federal fiscal project year starting October 1 and ending September 30. RSA The Rehabilitation Services Administration At The United States Department Of Education, Office Of Special Education And Rehabilitative Services. SECTION 722 STATE A state where RSA issues grants under part c directly to eligible agencies, i.e., CILs. SECTION 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. SERVICES PROVIDER Can mean: 1) a DSU that directly provides IL services to consumers 2) a CIL 3) an entity that provides IL services under a grant or contract; and is delegated responsibility for the determination of eligibility for IL services. SILC The Statewide Independent Living Council established in each state as required by sections 704 and 705 of the act. SILS A State Independent Living Services program funded under part B, chapter 1 of title VII of the act. SPIL A State Plan Of Independent Living jointly Developed and signed by the director of the designated state unit; and the chairperson of the statewide independent living council, acting on behalf of and at the direction of the council. The plan shall ensure the existence of appropriate planning, financial support and coordination, and other assistance to appropriately address, on a statewide and comprehensive basis, needs in the state for: (A) The provision of state IL services (B) The development and support of a statewide network of centers for independent living (C) Working relationships between programs providing IL services, CILs, the state VR program, and other programs providing services for individuals with disabilities. STATE The term state includes, in addition to each of the several states of the united states, the district of Columbia, the commonwealth of Puerto Rico, The United States Virgin Islands, Guam, American Samoa, And The Commonwealth Of The Northern Mariana Islands, except where otherwise noted. Question: What is the Structure of the Annual 704 Report? Answer: The 704 report is composed of part I and part II Part I contains reports of the SILC's and DSU's activities for the reporting year. It also contains data from consumer service records when 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, work plans for the next year, and data from consumer service records maintained by the CIL. It also contains any necessary budget amendments for the next fiscal year. Activities and plans regarding the current federal fiscal year are not typically discussed in part ii. The subpart structure of part II is as follows: (A) Subpart IIA - Administrative Data: A report on resources received and expended during the reporting year. (B) Subpart IIB - Numbers And Types Of Individuals With Significant Disabilities Receiving Services Either Directly From The Dsu Or Through Grants Or Contracts: Provides information from CSRs on the numbers and types of consumers receiving IL services. (C) Subpart IIC - Individual And Community Achievements And Services: A report of how much, the type, and overall community work and the results of such work. This subpart should reflect the community and individual IL services provided. (D) Subpart IID - Applicant Self Evaluation Based On The Sic Compliance Indictors: A measure of the extent to which a CIL is in compliance with the standards in section 725(b) of the act and the indicators of minimum compliance with the standards in 34 CFR 366, subpart G. (E) Subpart IIE - Comparison Of Program Activities With The Reporting Year Work Plan And With The Planned Activities In The Year Immediately Preceding The Reporting Year: A comparison of the CIL's activities in the reporting year with the CIL's proposed activities in the work plan. This shall include: (1) A comparison of activities and accomplishments during the reporting year with the goals and activities in the reporting year's work plan. (2) Descriptions of significant innovative activities or practices not reported elsewhere that could be replicated/used by other states and/or CILs. (3) Descriptions of substantial problems or difficulties, particularly problems that may affect compliance and alternative resolutions explored. (F) Subpart IIF - Next Year's Plans: this section includes the CIL's work plans for the next fiscal year and identification of the cil's training and technical assistance needs. (G) Subpart IIG - Budget Summary: Submittal of budget information for the remaining years of the grant or a revised budget as appropriate. Question: Who must complete the 704 Part II Report? Answer: All Centers for Independent Living must complete part II of the 704 report. Question: Where must the 704 Part II report be submitted? Answer: CILs submit the 704 Report based on whether to center is located in a Section 722 State or a Section 723 State. Section 722 States: (A) The Part C funded CILs will submit an original and three copies (one copy in electronic form), as described in the transmittal letter. The original and two copies (one electronic) of the part ii report go to RSA regional office and one copy goes to the SILC. If the CIL is receiving both part b and part c funds, a fourth copy of the report should also be submitted to the DSU. (B) CILs funded solely with title VII, chapter 1, part b of the act or state funds will submit their part II reports to the DSU and the SILC by the date established by the DSU. The DSU will then transmit the CIL report to RSA with their part I report. Section 723 States: CILs file their part II reports with the DSU and the SILC. The state aggregates the data and summarizes other information in the part ii reports with their part I report and attaches 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. Question: When Must the CILs Sumit the 704 Part II Report to RSA? Answer: The due date is determined by the location of the CILs in Section 722 States or Section 723 States. Section 722 States: Part C funded CILs must submit the 704 part II report to RSA regional offices postmarked by January 31, 2001, for the preceding federal fiscal year (10/1/99 - 9/30/00). Section 723 States: Information from the part II Report is included in the aggregate Part I Report to RSA regional offices, which must be postmarked by February 28, 2001, for the preceding Federal Fiscal Year (10/1/99 - 9/30/00). Question: How long must records be retained? Answer: Three Years The information provided in this report by Federal grantees is subject to confirmation at an on-site 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 three years (Authority: 34 CFR 74.53). Instructions 704 PART II Instructions: 704 Part II General Instructions: Please respond to each subpart of this preprint. 1) When a subpart requests a description, lists, or other non-data information, but does not apply to the DSU, SILS, CILs and/or other entities a "not applicable" response is appropriate. 2) When a subpart requests data or numerical response, but does not apply to the DSU, SILC, CILs and/or other entities, enter zero, "0". Specific Instructions: Please carefully read the instructions below for Subpart IIA through Subpart IIG and provide the requested details. Subpart IIA - Administrative DATA Subpart IIAI - Sources and Amounts of Funds and Resources (704(m)(4)(D) of the Act; 34 CFR Parts 74 and 75) List amounts of all resources received by CIL from sections (A-C) during the federal fiscal reporting year. Round off to the nearest dollar any funds ending with cents (i.e. $240,010.87 ® $240,011) Add lines 1-12 to get the total resources for section (D) Identify the total amount of "pass through" funds in section (E) Subtract section (D) from section (E) to get net operating resources (F) Subpart IIB - Numbers and types of individuals with significant disabilities reciving services either directly from the CIL or through grants or contracts (Section 13, 704(m)(B) and (D); 34 CFR 364.53) Subpart IIBI - Consumers Served During the Reporting Year Include Active Consumer Service Records (CSRs) for all consumers served during the year. (A) Enter the number of active CSRs carried over from September 30 of the preceding year. (B) Enter the number of new CSRs initiated since October 1 of the reporting year. (C) Enter the total number of consumers served during the year. (A) + (B) = (C) Subpart IIBII - Consumer CSRs Closed by September 30 of the Reporting Year Include in this count of consumer records those that have been purged from the active CSR files because the individual has: (A) Moved (B) Withdrew/stated that he or she had no further interest in the program (C) Died (D) Completed all goals set (E) For any reason is no longer an active consumer (F) Use this formula to derive at the total number of closed CSRs: (A) +(B) + (C) + (D) + (E) = (F) Subpart IIBIII - Consumer CSRs Active on September 30 of the Reporting Year Use this formula to derive at the total number of consumers remaining active on September 30 of the reporting year: Subpart IBI (C) - Subpart IBII (F) = Subpart IBIII Please note - For the remaining sections of Subpart IIB, RSA intends that the demographic information includes ALL consumers served during the year. Subpart IIBIV - Consumer Plans and Waivers For the total number of consumers served during the reporting year, indicate: (A) The number of individuals who signed a waiver (B) The number of individuals with whom an ILP was developed Subpart IIBV - Age Enter the number of consumers served in each age category. Subpart IIBVI - Gender Enter the number of males and females served during the reporting year. Please note - the race and ethnicity categories below reflect the standards announced in OMB's decision (10/30/97 Fed. Reg.): Federal programs, as soon as possible but no later than 2003, should adopt these standards. Subpart IIBVII - Ethnicity (Select one) Enter total number served for categories below: (A) Hispanic or Latino (B) Not Hispanic or Latino Subpart IIBVIII - Race (Choose one or more) Enter a count of individuals based on self-identification. (A) American Indian or Alaska Native - A person having origins in any of the original peoples of North America and who maintains cultural identification through affiliation or community identification. (B) Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian subcontinent. (C) Black or African American - A person having origins in any of the Black racial groups of Africa. (D) Hispanic or Latino - A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture origin. (E) Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii or other Pacific Islands, and who maintains cultural identification through affiliation or community identification. (F) White - A person having origins in any of the original peoples of Europe, North Africa, or the Middle East. Subpart IIBIX - Disability Enter a count of individuals in each category at the end of the reporting year. (These categories are meant to describe the functional limitations involved with the disability rather than a grouping of specific diagnoses of disability.) Subpart IIC - Individual and Community Achievements and Services Report the total number of goals set by consumers and the number of goals met by consumers during the reporting year. The consumer is the individual who determines whether or not a goal is met. Please classify goals in the following categories: Subpart IICI - Individual Consumer Achievements (A) Self-Advocacy/Self-Empowerment - Goals involving either improvement in a consumer's ability to represent himself/herself with public and/or private entities or ability to make key decisions involving himself/herself. (B) Communication - Goals involving either improvement in a consumer's ability to understand communication by others (receptive skills), and/or improvement in a consumer's ability to share communication with others (expressive skills). (C) Mobility/Transportation - Goals to improve a consumer's access to her/his life space, environment, and community. This may occur by improving the consumer's ability to move, travel, transport himself/herself, or use public transportation. (D) Community Services - Goals that provide for a change in living situations with increased autonomy for the consumer. This may involve a consumer's goals related to obtaining/modifying an apartment or house. (E) Educational - Goals of an academic or training nature that are expected to improve the consumer's basic knowledge or increase her/his ability to perform certain skills deemed to increase her/his independence consistent with IL philosophy. (F) Vocational - IL goals related to obtaining, maintaining, or advancing in employment. (G) Self-Care - Goals to improve/maintain a consumer's autonomy with respect to activities of daily living such as personal grooming and cleaning, toileting, meal preparation, shopping, eating, etc. (H) Information Access/Technology - Goals related to a consumer obtaining and/or using a computer or other assistive technology, devices, or equipment, also a consumer's goal of developing skills in using information technology, e.g., emerging computer screen-reading software. (I) Personal Resource Management - Goals related to a consumer learning to establish and maintain a personal/family budget, managing a checkbook, and/or obtaining knowledge of available direct and in-direct resources related to income, housing, food, medical, and/or other benefits. (J) Other - IL goals not included in the above categories. Subpart IICII - Individual Services List the number of consumers receiving each of the following services during the reporting year. The total of these numbers is not expected to equal the number of consumers served, as a consumer may receive several different services during the reporting year. However, a single individual should be counted only once for each service received during the reporting year. Individuals included in this section have CSRs (except individuals receiving only information and referral [I&R] services need not have CSRs). I&R services may be provided to anyone with the sole record being the number of individuals provided I&R services. (A) Advocacy/Legal Services - Assistance and /or representation in obtaining access to benefits, services, and programs to which a consumer may be entitled. (B) Assistive Devices/Equipment Services - Provision of specialized devices and equipment such as TDDs, wheelchairs and lifts, or the provision of assistance to obtain these devices and equipment from other sources. (C) Children's Services - The provision of specific IL services designed to serve individuals with significant disabilities under the age of six. (D) Communication Services - Services directed to enable consumers to better communicate such as: interpreter services, training in communication equipment use, Braille instruction, and reading services. (E) Counseling and Related Services - These include information sharing, psychological services of a non-psychiatric, non-therapeutic nature, parent-to-parent services, and related services. (F) Family Services - Services provided to the family members of an individual with a significant disability when necessary for improving the individual's ability to live and function more independently, or 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, Home Modifications, and Shelter Services - These services are 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 individual for a period not to exceed eight weeks during any six-month period. (H) IL Skills Training and Life Skill Training Services - These may include instruction to develop independent living skills in areas such as personal care, coping, financial management, social skills, and household management. This may also include education and training necessary for living in the community and participating in community activities. (I) Information and Referral Services - Identify all individuals who requested this type of assistance. Some entities record this service using strokes on an answering pad without opening a CSR, others create a CSR or other such file for future contact and outreach. This is the only service (other then services to family members) that my be provided to all individuals, whether or not the individual has a disability. (J) Mental Restoration Services - Psychiatric restoration services including maintenance on psychotropic medication, psychological services, and treatment management for substance abuse. (K) Mobility Training Services - A variety of services involving assisting consumers to get around their homes and communities. (L) Peer Counseling Services - Counseling, teaching, information sharing, and similar kinds of contact provided to consumers by other people with disabilities. (M) Personal Assistance Services - These include, but are not limited to, assistance with personal bodily functions; communicative, household, mobility, work, emotional, cognitive, personal, and financial affairs; community participation; parenting; leisure; and other related needs. (N) Physical Restoration Services - Restoration services including medical services; health maintenance; eyeglasses; and visual services. (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 - Provision of, or assistance in obtaining through other sources, an adaptive device or appliance to substitute for one or more parts of the human body. (Q) Recreational Services - Provision or identification of opportunities for the involvement of consumers in meaningful leisure time activities. These may include such things as participation in community affairs and other recreation activities that may be competitive, active or quiet. (R) Rehabilitation Technology Services - 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, IL and/or recreation. (S) Therapeutic Treatment - Services provided by registered occupational, physical, recreational, hearing, language, or speech therapists. (T) Transportation Services - Provision of, or arrangements for, transportation. (U) Youth Services - Specific IL services designed and provided to individuals with significant disabilities, ages 6-17, and may include training to develop skills specifically designed for youth to promote self-awareness and esteem, develop advocacy and personal power skills, and the exploration of career options. (V) Vocational Services - Any services designed to achieve paid employment. (W) Other Services - Any IL services not listed above in A-V. Subpart IICIII - Individual Consumers in Community-Based Living (A) Indicate the number of consumers who received IL services in the reporting year who successfully relocated from nursing homes or other institutions to community-based living arrangements. Community-based living arrangements include apartments, privately owned housing, self-directed assisted living, or self-directed with family/friends. (B) Indicate the number of consumers for whom IL services prevented the necessity of entering nursing homes or other institutions. These consumers should have received significant IL services that enabled them to continue living in a community-based living arrangement. Subpart IICIV - Community Change Achievements Report the total number of goals for community change set and met. Community change has not been captured in a uniform manner in prior versions of this annual performance report. Each "Community Change Achievement" goal set/met would be expected to benefit many people and involve the use of a significant amount of resources over several months to several years to bring about the change. Goals should be broad and reflect consumer needs (for example, rather than counting curb cuts, a goal may involve implementing an education and advocacy campaign to cut curbs in a large section of a city where curb cuts either don't exist or are scattered). Annual goals of a percentage or numerical target less than 100% change may be set, e.g., establish an annual goal of increasing recreational options offered by the city and county for individuals with disabilities by 20% (or 6 new options) each year for the next 5 years. (A) Community Integration - Goals involve the establishment or operation of a program to assist consumers in relocating from nursing homes or other institutions into the community. Other goals in this category would include working with public and private entities to establish new community options or capacity to meet the needs of consumers, or revising to include people with significant disabilities in existing community options or capacities that have not previously included individuals with significant disabilities. (B) Collaboration - Goals involve the establishment of new strategic alliances through communication, cooperation, and coordination with other stakeholder entities. Goals may also include the development of new coalitions to maximize utilization of community resources or open new resource development opportunities. (C) Educational - Goals include creating or facilitating the creation of academic or training programs designed to meet the transition from school to independent living and school to work needs of individuals with significant disabilities (D) Housing Opportunities/Home Modification - Goals include creating or facilitating the creation of new community options or capacity to meet the housing needs of consumers. (CILs may not provide residence to consumers, but should work with community housing providers to ensure that consumers have affordable/accessible options to live in communities.) (E) Information Access/Technology - Goals involve creating or facilitating the creation of new community options to meet information access or technology needs of individuals with significant disabilities in the community. Goals in this category would include the establishment of a wide range of options from a program to give computers to consumers to a campaign to get all area restaurants to have Braille menus for their customers who are blind. (F) Mobility/Transportation - Goals include the establishment, or facilitating the creation of, new or substantially improved programs or services to increase consumers' access to their life space, environment, and community. Programs could include personal mobility programs for individuals who are blind or have cognitive impairments, public transit education programs designed to increase use of existing transit systems, or the creation of new consumer transportation. (G) Personal Assistant Services - Goals include the establishment or expansion of program(s) to meet the personal assistance needs of individuals with significant disabilities. (H) Physical/Attitudinal Barrier Removal - Goals include the creation or operation of programs or campaigns designed to remove community physical or attitudinal barriers to the full participation of individuals with significant disabilities in society. Please do NOT include goals listed under other categories. (I) Vocational - Goals include the establishment/inclusion of people with disabilities in programs to obtain, maintain, or advance in employment. (J) Other - Report community change goals not included in the above categories. Subpart IICV - Community Services Report the number of hours of community service provided in each of the following categories. Please round to nearest whole hour. (Please note - Report the number of hours of community services, not the number of hours times the number of participants. For Example: If you give a one-hour presentation with 50 participants, you should count one hour of community service, NOT 50 hours.) (A) Community and Systems Advocacy - Includes efforts to implement local and State policy changes to make facilities, services, and opportunities available and accessible to individuals with disabilities. (B) Outreach Efforts - Entails the location of, and encouragement to use services for unserved/underserved populations of individuals with significant disabilities. (C) Publications - Includes time spent in the creation and distribution of publications including accessibility guides, disability awareness brochures, ADA information, etc. (D) Community Education/Integration Services - Activities and information programs to enhance the community's awareness of disabilities and disability issues, e.g., local TV, radio, or newspaper campaigns. (E) Maintaining Registries/Libraries/Databases - Includes activities related to creating and maintaining directories for personal assistants, recreation opportunities, accessible transportation, accessible housing, and other support services. Includes activities related to the establishment or maintenance of libraries and/or databases to support information and referral services or consumer and staff education. (F) Collaboration/Networking - Activities related to building coalitions or collaborative partnerships designed to expand the participation of individuals with significant disabilities in community services and programs. (G) Other Services - Community activities that do not fit in any of the above definitions. (H) To derive at GRAND TOTAL HOURS add (A) through (G): (A) + (B) + (C) + (D) + (E) + (F) + (G) = (H) Subpart IID - applicant self evaluation based on the six compiance indicators Please indicate your response by placing a check mark near the "Yes" or "No" and/or filling in the numbers as appropriate. Subpart IIE - Comparison of Program Activities with the reporting year work plan and with the planned activities in the year immediately preceding the reporting year Compare the CIL's activities in the reporting year with the CIL's proposed activities in the work plan. Please include: 1) A comparison of activities and accomplishments during the reporting year with the goals and activities included in the reporting year's work plan in the areas (A) through (K) listed below. 2) Descriptions of significant innovative activities or practices, not reported elsewhere, that could be replicated/used by other CILs. 3) Descriptions of substantial problems or difficulties, particularly problems that may affect compliance, alternative resolutions explored, and explanation of results, if any. (A) Advocacy Efforts - describe the CIL's individual and systems advocacy activities, including outcomes accomplished or progress made. Describe changes made to the advocacy plan since its submission and the results of revised efforts. The narrative should include discussion of: (1) Community actions, rallies, rights testing, and related activities (2) Technical assistance and related activities (3) Collaboration, including communication, coordination, and cooperation with other agencies and groups (4) Education campaigns (5) Legal actions (B) Outreach Efforts - 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. Discuss the CIL's percentage of minorities and/or other unserved/underserved individuals receiving services when compared to population percentage in the service area. Please present information on needs assessments, if any, of unserved or underserved populations. (C) Community and Individual IL Services - Identify the community and IL services the CIL provided during the reporting year. This should include a brief but complete overview of all the CIL's IL service goals, outcomes accomplished or progress made. (D) Individuals Served by County - List the counties served by the CIL and the number of consumers served in each county. Example: Adams County - 24 Bates County - 62 (E) Consumer Satisfaction Appraisal - Provide a brief summary of the type(s) of opportunities provided consumers to express satisfaction (e.g., focus groups, written survey, telephone survey, public meeting, etc.) Including the number of individuals assessed, the number of respondents, and assessment outcome by percentage (e.g., very satisfied V%, mostly satisfied W%, dissatisfied Y%, or very dissatisfied Z%) or a summary narrative. (f) Response to Needs - Describe the CIL's response to any needs identified in response to consumer satisfaction appraisals and other community needs assessment information. Responses may include: (1) Making adjustments in the CIL's resource allocations to meet consumers needs (2) Advocacy effort intended to expand the options available to consumers through the creation of new or modification of existing programs (3) Corrective action plan addressing specific identified needs in the CIL's compliance areas, activities, or operation (4) Staff rewards for exceeding high goals (G) Resource Development Plans - Report results of activities under the resource development plan for the reporting year. Please note any exemplary replicable methods of resource development. (H) Training plans - Provide a report on staff and governing board training activities during the reporting year. Training areas may include staff development, IL Philosophy, ADA, Self-Advocacy and Personal Power, moving people out of nursing homes, or other training areas. (I) Innovative Activities - Describe significant activities not accounted for elsewhere in the report - highlight innovative service and/or advocacy activities that could be replicated and used by other CILs. (J) Consistency with the state plan for independent living (SPIL) - describe how the CIL's activities for the reporting year were consistent with the SPIL. (K) Description of substantial problems - describe major obstacles and issues encountered by the CIL during the reporting year. Highlight innovative resolutions that could be replicated and used by other CILs. Subpart IIF - next year's plans Discuss the following topics based on next year's work plan. Subpart IIFI - Narrative Please discuss the following: (A) Advocacy Efforts - Describe the CIL's individual and systems advocacy goals, planned activities, projected completion dates, and anticipated outcomes. Description may include discussion of : (1) Community actions, rallies, rights testing, and related activities (2) Technical assistance and related activities (3) Collaboration, including communication, coordination, and cooperation with other agencies and groups (4) Education campaigns (5) Legal actions (B) Outreach Efforts - Describe the CIL's plans for outreach activities to consumers who are members of populations of individuals with significant disabilities, including minorities, who are unserved or underserved (C) Community and Individual IL Services - Identify the community and IL services the CIL anticipates providing during the next federal fiscal year. This should include a brief but complete overview of all the CIL's IL service goals, planned activities, projected completion dates, and anticipated outcomes that are not described elsewhere. (D) Individuals Served by County - List the counties the CIL proposes to serve for the coming year and the anticipated number of consumers that will be served in each county. Example: Adams County - 24 Bates County - 62 (E) Consumer Satisfaction Appraisal - Describe planned activities to provide opportunities for consumers to express their satisfaction/dissatisfaction with the CIL's services and policies in facilitating their achievement of IL goals. In addressing this requirement, CIL's: (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 and telephone surveys, etc.. (F) Response to needs - describe the CIL's proposed response to any needs identified in consumer satisfaction appraisals and other community needs assessment information. Such responses may include: (1) Making adjustments in the CIL's resource allocations to meet consumers needs (2) Advocacy effort intended to expand the options available to consumers through the creation of new or modification of existing programs (3) Corrective action plan addressing specific identified needs in the CIL's compliance areas, activities, or operation (4) Staff rewards for exceeding high goals (G) Resource development plans - Describe the CIL's plans for obtaining and increasing funding, including in-kind, from sources other that Title VII of the act. (H) Training plans - Describe plans for training the CIL governing board and staff. Training areas may include staff development, IL philosophy, ADA, self-advocacy and personal power, moving people out of nursing homes, or other training areas. (I) Innovative activities - Describe any significant activities not accounted for elsewhere in the report that the CIL proposes to put into place for next year. (J) Consistency with the state plan for independent living (SPIL) - Describe how the CIL's proposed activities are were consistent with the SPIL. (K) Description of substantial problems - Describe any major obstacles and issues the CIL anticipates for the coming year and proposed resolutions. Subpart IIFII - Training and Technical Assistance Needs for the Next Fiscal Year Please choose up to 10 priority needs, using the boxes to the right, reflecting technical assistance and training needs of the center. Report any comments or clarifications using the blank space at the end of the subpart. The needs identified will be used to design CIL training opportunities offered through the training and technical assistance cooperative agreement, currently IL-NET. Please provide any additional comments in the write-in space provided. Subpart IIG - Budget Summary A CIL that has negotiated a budget for each year of its grant award is not required to submit ED Form No. 524 unless certain changes are anticipated in the budget for the upcoming year. These changes, which require RSA approval, are specified in 34 CFR 74.25 and 34 CFR 80.30. The following are instructions for completing ED Form No. 524: (A) 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 in 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, columns (a)-(e): show the total budget request for all project years. If funding is requested for only one year, leave this space blank. (B) 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 contributions 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. (C) Section (C) - Other Budget Information Pay attention to applicable program specific instructions, if attached. Provide an itemized budget breakdown, by project year, for each budget category listed in Sections A and B above. 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. If applicable to this program, provide the rate and base on which fringe benefits are calculated. Provide other explanations or comments you deem necessary. RSA Directory Regions: Region I Regional Commissioner: Mr. John Szufnarowski Dept. of Education, OSERS J.W. McCormack Post Office and Court House Rm 232 Boston, MA 02109 (617) 223-4086 VOICE (617) 223-4573 TDD (617) 223-4573 FAX IL Program: Richard Anderson Illeana Prancan *CT, ME, NH, RI, VT, MA Region II Regional Commissioner: Mr. John Szufnarowski Dept. of Education, OSERS 75 Park Place, Rm 1208 New York, NY 10007 (212) 264-4016 VOICE (212) 264-4028 TDD (212) 264-3029 FAX IL Program: Richard Anderson Janice Plumer *NJ, PR, VI, NY Region III Regional Commissioner: Dr. Ralph Pacinelli Dept. of Education, OSERS The Wanamaker Building Suite 512 100 Penn Square East Philadelphia, PA 19107 (215) 656-8531 VOICE (215) 656-6186 TDD (215) 656-6188 FAX IL Program: Keith Beichner Margurite Pickney *DC, DE, MD, VA, WVA, PA Region IV Regional Commissioner: Dr. Ralph Pacinelli Dept. of Education, OSERS 61 Forsyth St. SW Suite 18T91 Atlanta, GA 30303-3104 (404) 562-6330 VOICE (404) 562-6347 TDD (404) 562-6346 FAX IL Program: Sue Rankin-White Dan Hunsberger *AL, FL, KY, NC, SC, TN, GA, MS Region V Regional Commissioner: Dr. Douglas Burleigh Dept. of Education, OSERS 111 N. Canal Rm. 1048 Chicago, IL 60606 (312) 886-8630 VOICE (312) 353-9694 TDD (312) 353-8623 FAX IL Program: Zilpha Hibner Kathy Niemi *IN, MI, MN, OH, WI, IL Region VI Regional Commissioner: Mr. Loerance Deaver Dept. of Education, OSERS 1999 Bryan St. Rm. 2740 Dallas, TX 75201-6817 (214) 880-4927 VOICE (214) 880-4833 TDD (214) 880-4931 FAX IL Program: Mike McGill Loretta Thomas *AK, LA, MN, OK, TX Region VII Regional Commissioner: Dr. Douglas Burleigh Dept. of Education, OSERS 10220 N. Executive Hills Blvd Kansas City, MO 64153-1367 (816) 880-4107 VOICE (816) 891-0985 TDD (816) 891-0807 FAX IL Program: Rodney King Mari Kierstein *IA, KS, NB, MO Region VIII Regional Commissioner: Mr. Loerance Deaver Dept. of Education, OSERS FOB Suite 310 - 1244 Speer Blvd Denver, CO 80204-3582 (303) 844-2135 VOICE (303) 844-2890 TDD (303) 844-6269 FAX IL Program: Mike McGill Patty Burrows *MT, ND, SD, UT, WY, CO Region IX Regional Commissioner: Mr. Gilbert Williams Dept. of Education, OSERS FOB Rm 215 - 50 United Nations Plaza San Francisco, CA 94102 (415) 437-7840 VOICE (415) 556-3323 TDD (415) 437-7848 FAX IL Program: Gilbert Williams Gayle Palumbo *AZ, HI, NV, Gu, AS, CA, CNMI Region X Regional Commissioner: Mr. Gilbert Williams Dept. of Education, OSERS 915 Second Ave, Rm 2848 Seattle, WA 98174-1099 (206) 220-7840 VOICE (206) 220-7849 TDD (206) 220-7842 FAX IL Program: Chris Smith Diana Koreski *AK, ID, OR, WA Central Office: IL Team Leader: Mr. James Billy Division of Special Projects Rehabilitation Services Administration 330 C Street SW Rm. 3326 Washington, D.C. 20202-2741 (202) 205-9362 VOICE (202) 260-9424 FAX (202) 205-8243 TDD E-mail: james_billy@ed.gov CIL Program Officer: Ms. Brenda Bercegeay Division of Special Projects Rehabilitation Services Administration 330 C Street SW Rm. 3332 Washington, D.C. 20202-2741 (202) 205-8291 VOICE (202) 260-9424 FAX (202) 205-8243 TDD E-mail: brenda_bercegeay@ed.gov Director, Special Projects Division: Thomas E. Finch, Ph.D. Rehabilitation Services Administration 330 C Street SW Rm. 3038 Washington, D.C. 20202-2741 (202) 205-8292 VOICE (202) 260-9424 FAX (202) 205-8243 TDD E-mail: tom_finch@ed.gov Reporting Instrument OMB Control Number: 1820-0606 Expiration Date: November 30, 2003 UNITED STATES DEPARTMENT OF EDUCATION Office of Special Education and Rehabilitation Services REHABILTATION SERVICES ADMINISTRATION Part II PRE-PRINT The Centers for Independent Living Programs Chapter 1, Title VII of the Rehabilitation Act, as Amended FISCAL YEAR________ With Citations GRANT # Name of Center Acronum for Center (if applicable): State: Counties Served: Subpart IIA - Administrative DAta Subpart IIAI - Sources and Amounts of Funds and 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 Resources (7) Foundations, Corporation, Or Trust Grants $______________ (8) Donations From Individuals $______________ (9) Membership Fees $______________ (10) Investment Income/Endowment $______________ (11) Fees For Service (Program Income, etc.) $______________ (12) Other Resources (In-Kind, Fund Raising, etc.) $______________ (D) Total Resources (Sum Of Lines 1-12) $______________ (E) Amount Of Total Resources That "Pass Through" To Consumers, E.G., Personal Assistance Services Funds $______________ (F) Net Operating Resources (D) - (E) = (F) $______________ * Include "pass through" funds. Subpart IIB - Numbers and types of individuals with significant disabilities reciving services either directly from the DSU or through grants or contracts (Section 13, 704(m)(B) and (D); 34 CFR 364.53) Subpart IIBI - Consumers Served During the Reporting Year (A) CSRS carried from previous year __________ (B) CSRS Started Since Oct. 1 Of The Reporting Year __________ (C) Total consumers served: (A) + (B) =(C) __________ Subpart IIBII - Consumer CSRs Closed by September 30 of the Reporting Year (A) Moved __________ (B) Withdrew __________ (C) Died __________ (D) Completed all goals set __________ (E) Other __________ (F) Total Closed CSRS: (A) + (B) + (C) + (D) + (E) = (F) __________ Subpart IIBIII - Consumer CSRs Active on September 30 of the Reporting Year Subpart IBI (C) - Subpart IBII (F) = Subpart IBIII __________ Subpart IIBIV - Consumer Plans and Waivers (A) Number of individuals who signed a waiver __________ (B) Number of individuals with whom an ILP was developed __________ Subpart IIBV - Age (A) Under 6 __________ (B) 6 - 17 __________ (C) 18 - 22 __________ (D) 23 - 64 __________ (E) 65 & Over __________ (F) Unknown __________ Subpart IIBVI - Gender (A) Female _________ (B) Male _________ Subpart IIBVII - Ethnicity (Select one) (A) Hispanic or Latino __________ (B) Not Hispanic or Latino __________ Subpart IIBVIII - Race (Choose one or more) (A) American Indian or Alaska Native __________ (B) Asian __________ (C) Black or African American __________ (D) Hispanic or Latino __________ (E) Native Hawaiian or Other Pacific Islander __________ (F) White __________ Subpart IIBIX - Disability (A) Cognitive __________ (B) Mental/Emotional __________ (C) Physical __________ (D) Hearing __________ (E) Vision __________ (F) Multiple Disability __________ (G) Other _________ Subpart IIC - Individual and Community Achievements and Services Subpart IICI - Individual Consumer Achievements Goals Set Goals Met (A) Self-Advocacy/Self-Empowerment __________ __________ (B) Communication __________ __________ (C) Mobility/Transportation __________ __________ (D) Community Services __________ __________ (E) Educational __________ __________ (F) Vocational __________ __________ (G) Self-Care __________ __________ (H) Information Access/Technology __________ __________ (I) Personal Resource Management __________ __________ (J) Other __________ __________ Subpart IICII - Individual Services (A) Advocacy/Legal Services __________ (B) Assistive Devices/Equipment Services __________ (C) Children's Services __________ (D) Communication Services __________ (E) Counseling And Related Services __________ (F) Family Services __________ (G) Housing, Home Modifications, And Shelter Services __________ (H) Il Skills Training And Life Skills Training Services __________ (I) Information And Referral Services __________ (J) Mental Restoration Services __________ (K) Mobility Training Services __________ (L) Peer Counseling Services __________ (M) Personal Assistance Services __________ (N) Physical Restoration Services __________ (O) Preventive Services __________ (P) Prostheses And Other Appliances __________ (Q) Recreational Services __________ (R) Rehabilitation Technology Services __________ (S) Therapeutic Treatment __________ (T) Transportation Services __________ (U) Youth Services __________ (V) Vocational Services __________ (W) Other Services __________ Subpart IICIII - Individual Consumers in Community Based-Living (A) How many individuals were successfully relocated from nursing homes or other institutions to community-based living arrangements? __________ (B) How many individuals for whom IL services prevented the necessity of entering nursing homes or other institutions and therefore continued living in community-based living arrangement? __________ Subpart IICIV - Community Change Achievements Goals Set Goals Met (A) Community Integration __________ __________ (B) Collaboration __________ __________ (C) Educational __________ __________ (D) Housing Opportunities/Home Modification __________ __________ (E) Information Access/Technology __________ __________ (F) Mobility/Transportation __________ __________ (G) Personal Assistant Services __________ __________ (H) Physical/Attitudinal Barrier Removal __________ __________ (I) Vocational __________ __________ (J) Other __________ __________ Subpart IICV - Community Services (A) Community And Systems Advocacy __________ (B) Outreach Efforts __________ (C) Publications __________ (D) Community Education/Integration Services __________ (E) Maintaining Registries/Libraries/Databases __________ (F) Collaboration/Networking __________ (G) Other Services __________ (H) Grand Total Hours [Add (A) Through(G)] __________ Subpart IID - Applicant Self-Evaluation based on the Six Compliance Indicators Subpart IIDI - Compliance Indicator 1: Philosophy (A) Consumer Control (1) Please complete the chart below CIL Employees Total Positions Number Of Persons With Disabilities Number Of Persons Who Are Minorities Decision Making Positions Staff Positions (2) Over 50 percent of the CIL's Governing Board is composed of individuals with significant disabilities _______Yes _______No (B) Self-Help And Self-Advocacy During the reporting year the CIL has conducted activities that promote self-help and self-advocacy among individuals with significance disabilities. _______Yes _______No (C) Development Of Peer Relationships And Peer Role Models During the reporting year the CIL has conducted activities that promote the development of peer relationships and peer role models among individuals with significant disabilities as instructors and counselors in its programs. _______Yes _______No (D) Equal Access (1) Ensures equal access to the CIL's services, programs, activities, resources, and facilities, whether publicly or privately funded. Equal access means that the same access is provided to the individual with a disability regardless of the individual's type of disability. _____Yes _______No (2) The CIL advocates for and conducts activities that promote equal access to all services, programs, activities, resources, and facilities in society, whether public or private, and regardless of funding sources for individuals with significant disabilities. Equal access means that the same access is provided to the individual with a disability regardless of the individual's type of disability. _______Yes _______No (3) The CIL makes available, as appropriate, all written policies, materials, and IL services in alternative formats. _______Yes _______No Subpart IIDII - Compliance Indicator 2: Provision of Services on a Cross-Disability Basis The center provides the following: (A) IL services to eligible individuals or groups of individuals without restrictions based on the particular types of disabilities that the individuals or groups of individuals may have. _______Yes _______No (B) 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. _______Yes _______No (C) 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 Subpart IIDIII - Compliance Indicator 3: Independent Living Goals (A) The CIL maintains a CSR for each consumer that contains: (1) Documentation concerning eligibility or ineligibility of services _______Yes _______No (2) Either an ILP or a waiver of the ILP _______Yes _______No (3) IL goals or objectives established with the consumer _______Yes _______No (B) The CIL maintains documentation indicating: (1) The CIL notifies all consumers of their right to develop or waive the development of the ILP _______Yes _______No (2) The number of ILPS developed by consumers receiving services from the CIL _______Yes _______No (3) 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) 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 the SILC ______Yes _______No (5) The number of waivers signed by consumers receiving services from the CIL stating that an ILP is unnecessary _______Yes _______No Subpart IIDIV - Compliance Indicator 4: Community Options and Community Capacity (A) During the reporting year, the CIL promoted: (1) Increased availability and improved quality of community-based programs that serve individuals with significant disabilities _______Yes _______No (2) Removal of any existing architectural, attitudinal, communication, environmental, or other type of barrier that prevents the full integration of individuals with significant disabilities into society _______Yes _______No (B) During the reporting year, the CIL performed at least one activity in each of the following categories: (1) Community advocacy _______Yes _______No (2) Technical assistance to the community on making services, programs, activities, resources, and facilities in society accessible to individuals with significant disabilities _______Yes _______No (3) Public information and education _______Yes _______No (4) 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 services area _______Yes _______No (5) 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 services area _______Yes _______No Subpart IIDV - Compliance Indicator 5: IL Core Services and Other IL Services (A) The CIL provides information and referral (I & R) services to all individuals who request this type of assistance or service from the center, in formats accessible to the individual requesting these services _______Yes _______No (B) As appropriate in response to requests, the CIL provides to individuals with significant disabilities who are eligible for IL services from the CIL the following services: (1) IL skills training _______Yes _______No (2) Peer counseling services (including cross-disability peer counseling) _______Yes _______No (3) Individual and systems advocacy _______Yes _______No (4) As appropriate, two or more of the IL services defined in title VII, section 6(17) of the act _______Yes _______No Subpart IIDVI - Compliance Indicator 6: Resource Development Activities The CIL conducts resource development activities to obtain funding from sources other than chapter 1 of title vii of the act _______Yes _______No Subpart IIE - Comparison of Program Activities with the reporting year work plan and with the planned activities in the year immediately preceding the reporting year In the space provided , compare the CIL's activities in the reporting year with the CIL's proposed activities in the work plan for each category listed below. Additional space and/or pages may be added as needed for each category. PLEASE REFER TO THE INSTRUCTIONS FOR SUBPART IIE TO ENSURE ALL REQUESTED INFORMATION IS DETAILED IN YOUR RESPONSES. (A) Advocacy Efforts - Describe the CIL's individual and systems advocacy activities and accomplishments. (B) Outreach Efforts - Describe the CIL's outreach activities to consumers of unserved/underserved populations. (C) Community And Individual Il Services - Identify the community and IL services the CIL provided during the reporting year. (D) Individuals Served By County - List the counties served by the CIL and the number of consumers served in each county. (E) Consumer Satisfaction Appraisal - Provide a brief summary of the type(s) of consumer satisfaction appraisal methods and results. (F) Response To Needs - Describe the CIL's response to needs identified in the consumer satisfaction appraisal. (G) Resource Development Plan - Report the results of resource development activities. (H) Training Plans - Report on staff and governing board training activities. (I) Innovative Activities - Describe significant activities not accounted for elsewhere in the report. (J) Consistency With SPIL - Describe how CIL activities were consistent with the SPIL. (K) Description Of Substantial Problems - Discuss major problems encountered and attempted resolutions. Subpart IIF - Next Year's Plans In the space provided, discuss the CIL's proposed activities for each category listed below. Additional space and/or pages may be added as needed for each category. PLEASE REFER TO THE INSTRUCTIONS FOR SUBPART IIF TO ENSURE ALL REQUESTED INFORMATION IS DETAILED IN YOUR RESPONSES. Subpart IIFI - Narrative (A) Advocacy Efforts - Discuss the CIL's advocacy goals. (B) Outreach Efforts - Describe the CIL's plans for outreach to unserved/underserved populations. (C) Community And Individual Il Services - Identify the community and IL services the CIL anticipates providing during the next federal fiscal year. (D) Individuals Served By County - list the counties the CIL proposed to serve and the anticipated number of consumers that will be served in each county. (E) Consumer Satisfaction Appraisal - describe activities planned to access consumer satisfaction. (F) Response to Needs - Describe the CIL's proposed response to needs identified in consumer satisfaction appraisals and needs assessments. (G) Resource Development Plans - Describe the CIL's plans for obtaining and increasing funding. (H) Training Plans - Describe plan for training the CIL staff and governing board. I) Innovative Activities - Describe any significant activities not accounted for elsewhere in this report. (J) Consistency With The SPIL - Discuss how the CIL's proposed activities are consistent with the SPIL. (K) Description of Substantial Problems - Discuss any anticipated problems and potential solutions. Subpart IIFII - Training and Technical Assistance Needs for the Next Fiscal Year Training and Technical Assistance Needs Choose up to 10 priority needs Rate items 1-10 with 1 being most important Advocacy/Leadership Development General Overview Community/Grassroots Organizing Individual Empowerment Systems Advocacy Legislative Process Applicable Laws General Overview And Promulgation Of Various Disability Laws Americans With Disabilities Act Air-Carrier's Access Act Fair Housing Act Individuals With Disabilities Education Act Medicaid/Medicare/Pas/Waivers/Long-Term Care Rehabilitation Act Of 1973, As Amended Social Security Act Workforce Investment Act Of 1998 Ticket To Work And Work Incentives Improvement Act Of 1999 Assistive Technologies General Overview Data Collecting and Reporting General Overview 704 Reports Dual Reporting Requirements Case Documentation Disability Awareness and Information Specific Issues Evaluation General Overview CIL Standards And Indicators Community Needs Assessment Consumer Satisfaction Surveys Focus Groups Government Performance Results Act And Title Vii Outcome Measures Financial: Grant Management General Overview Federal Regulations Budgeting Fund Accounting Financial: Resource Development General Overview Diversification of Funding Base Fee-for-Service Approaches For Profit Subsidiaries Fund-Raising Events of Statewide Campaigns Grant Writing Independent Living Philosophy General Overview Innovative Programs Best Practices Specific Examples Management Information Systems Computer Skills Software Marketing and Public Relations General Overview Presentation/Workshop Skills Community Awareness Networking Strategies General Overview Electronic Among CILs & SILCs Community Partners Program Planning General Overview of Program Management and Staff Development CIL Executive Directorship Skills Building Conflict Management and Alternative Dispute Resolution First-Line CIL Supervisor Skills Building IL Skills Modules Peer Mentoring Program Design Time Management Team Building Outreach to Unserved/Underserved Populations General Overview Disability Minority Institutionalized Potential Consumers Rural Urban SILC Roles/Relationship to CILs General Overview Development of State Plan for Independent Living Implementation (monitor & review) of SPIL Public Meetings Role and Responsibilities of Executive Board Role and Responsibilities of General Members Collaborations with In-State Stakeholders CIL Board of Directors General Overview Roles and Responsibilities Policy Development Recruiting/Increasing Involvement Volunteer Programs General Overview Optional Areas and/or Comments (write-in) Subpart IIG - Budget Summary Public reporting burden for this collection of information is estimated to vary from 13 to 22 hours per response, with an average of 17.5 hours per response, including the time reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Education, Information Management and Compliance Division, Washington, D.C. 20202-4651; and the office of management and budget, paperwork reduction project 1875-0102, Washington DC 20503. INSTRUCTIONS FOR ED FORM 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 program 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, columns (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 project 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 or other 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. U.S. DEPARTMENT OF EDUCATION BUDGET INFORMATION NON-CONSTRUCTION PROGRAMS OMB Control Number: 1890-0004 EXPIRATION DATE: 02/28/2003 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 Column Headings: BUDGET CATEGORIES PROJECT YEAR 1 (A) PROJECT YEAR 2 (B) PROJECT YEAR 3 (C) PROJECT YEAR 4 (D) PROJECT YEAR 5 (E) TOTAL (F) Row Headings: 1. PERSONNEL 2. FRINGE BENEFITS 3. TRAVEL 4. EQUIPMENT 5. SUPPLIES 6. CONTRACTUAL 7. CONSTRUCTION 8. OTHER 9. TOTAL DIRECT COSTS (LINES 1-8) 10. INDIRECT COSTS 11. TRAINING STIPENDS 12. TOTAL COSTS (LINES 9-11) ED FORM NO. 524 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 B - BUDGET SUMMARY NON-FEDERAL FUNDS Column Headings: BUDGET CATEGORIES PROJECT YEAR 1 (A) PROJECT YEAR 2 (B) PROJECT YEAR 3 (C) PROJECT YEAR 4 (D) PROJECT YEAR 5 (E) TOTAL (F) Row Headings: 1. PERSONNEL 2. FRINGE BENEFITS 3. TRAVEL 4. EQUIPMENT 5. SUPPLIES 6. CONTRACTUAL 7. CONSTRUCTION 8. OTHER 9. TOTAL DIRECT COSTS (LINES 1-8) 10. INDIRECT COSTS 11. TRAINING STIPENDS 12. TOTAL COSTS (LINES 9-11) SECTION C - OTHER BUDGET INFORMATION (SEE INSTRUCTIONS) ED Form No. 524 Signatures, Printed name, Title, phone Numbers Please sign and print your name, title and your phone number. SIGNATURE OF CENTER DIRECTOR DATE Name and title of Center Director phone number Signature of Board Chairman date Name and title of Board Chairman phone number Report Submission Information PLEASE MAIL: (A) one (1) hard copy and one (1) electronic copy - to RSA regional office. The hard copy will serve as the official copy of the 704 Report. If you do not have access to email, please provide your electronic copy on disk. (See transmittal letter for contact information.) (B) One (1) Electronic copy - to RSA central office. If you do not have access to email, please provide your electronic copy on disk. Send to attention of: Roslyn Thompson at Email: Roslyn_Thompson@Ed.Gov -Or- Attn: Roslyn Thompson 330 C Street, SW Rm. 3328 Washington, D.C. 20202-2741 (C) One (1) Electronic Copy - to independent living research utilization at TIRR. Send to: Dawn Heinsohn at Email: heinsohn@Bcm.Tmc.Edu -Or- Attn: Dawn Heinsohn ILRU 2323 South Shepherd, Ste. 1000 Houston, TX 77019 DUE DATES: For 722 States - copies must be sent no later than January 31, 2001. For 723 State - copies must be sent no later than February 28, 2001.