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Report Use & Instructions

Customized Employment

Report Name and Link Purpose of the Report Use and Submission Details
CE Discovery Profile Report (DVR-18010-E) Use this report to describe the activities completed during the Discovery Process. Submit once following completion of activities.
Job Development Plan and Monthly Report (DVR-18028-E) Use this report to describe the activities with a consumer to help prepare and plan for future job development and to identify employment and/or internship opportunities for a consumer.

Submit initially following completion of activities and plan section.

Submit monthly to reflect job development activity.

Plan section reviewed every 90 days and section submitted for the month.

Job Hire Report (DVR-17037-E) Use this report to notify DVR of specific information for position(s) offered to consumers, and anticipated support needs or strategies. Submit once following completion of activities and within 5 days of job hire offer.
Job Retention Report (DVR-17038-E) Use this report when no Systematic Instruction is authorized to describe efforts to ensure a consumer maintains employment. Submit Monthly when Retention is authorized.
Job and Task Analysis and Systematic Instruction Report (DVR-18212-E)

Use the Job and Task Analysis portions of report to explain the anticipated support needs of a consumer and strategies to meet that need at the beginning of Employment or Internship/Temporary Work.

Once the consumer has begun working, use Service Summary section of the report to detail efforts to support the consumer.

Complete the Job and Task Analysis portion within 1 calendar week of consumer's start date and submit it as soon as possible.

Submit the report at the end of each month in which the service was provided.

Transition to LTS Report (DVR-18037-E)

Use this report to describe ongoing consumer support needs to continue as they transition to Long Term Care.

Submit this report following agreement between all parties on the plan for transitioning services Long Term Support.

Submit once following completion of activities.

Individual Placement and Support

Report Name and Link Purpose of the Report Use and Submission Details
IPS Career Profile Report (DVR-18018-E) Use this report to describe the activities completed during the Career Profile Process. Submit once following completion of activities.
Job Development Plan and Monthly Report (DVR-18028-E)

Use this report to describe the activities with a consumer to help prepare and plan for future job development and to identify employment and/or internship opportunities for a consumer.

Submit initially following completion of activities and plan section.

Submit monthly to reflect job development activity.

Plan section reviewed every 90 days and section submitted for the month.

Job Hire Report (DVR-17037-E) Use this report to notify DVR of specific information for position(s) offered to consumers, and anticipated support needs or strategies. Submit once following completion of activities and within 5 days of job hire offer.
Job Retention Report (DVR-17038-E) Use this report when no Systematic Instruction is authorized to describe efforts to ensure a consumer maintains employment. Submit Monthly when Retention is authorized.
Job and Task Analysis and Systematic Instruction Report (DVR-18212-E)

Use the Job and Task Analysis portions of report to explain the anticipated support needs of a consumer and strategies to meet that need at the beginning of Employment or Internship/Temporary Work.

Once the consumer has begun working, use Service Summary section of the report to detail efforts to support the consumer.

Complete the Job and Task Analysis portion within 1 calendar week of consumer's start date and submit it as soon as possible.

Submit the report at the end of each month in which the service was provided.

Transition to LTS Report (DVR-18037-E)

Use this report to describe ongoing consumer support needs to continue as they transition to County supports.

Submit once following completion of activities.

Internship Temporary Work

Report Name and Link Purpose of the Report Use and Submission Details
Job Development Plan and Monthly Report (DVR-18028-E)

Use this report to describe the actions taken to identify employment and/or internship opportunities for a consumer.

Submit the report at the end of each month in which the service was provided.

Internship/Temporary work Report (DVR-18025-E)

Use the first half of this report to describe the specific conditions of an Internship/Temporary Work that has been secured.

Use the second half of this report to describe what the provider and consumer learned through the Internship/Temporary work. Submit this at the completion of the Internship/Temporary Work

Submit initially following completion of activities

Submit following Internship/Temporary Work conclusion

*If Systematic Instruction is provided during an I/TW, the I/TW report is only required at the beginning and end of the I/TW to detail consumer progress.

Internship/Temporary Work Agreement (DVR-17206-E)

Use this report to record agreement by the business, consumer and provider about the terms and conditions of an Internship/Temporary Work.

After DVR approval of proposed Internship/Temporary Work

Job Task Analysis and Systematic Instruction

Report Name and Link Purpose of the Report Use and Submission Details
Job and Task Analysis and Systematic Instruction Report(DVR-18212-E)

Use the Job and Task Analysis portions of report to explain the anticipated support needs of a consumer and strategies to meet that need at the beginning of Employment or Internship/Temporary Work.

Once the consumer has begun working, use Service Summary section of the report to detail efforts to support the consumer.

Complete the Job and Task Analysis portion within 1 calendar week of consumer's start date and submit it as soon as possible.

Submit the report at the end of each month in which the service was provided.

Job Preparation, Development, Hire, and Retention

Report Name and Link Purpose of the Report Use and Submission Details
Job Development Plan and Monthly Report (DVR-18028-E)

Use this report to describe the activities with a consumer to help prepare and plan for future job development and to identify employment and/or internship opportunities for a consumer.

Submit initially following completion of activities and plan section.

Submit monthly to reflect job development activity.

Plan section reviewed every 90 days and section submitted for the month.

Job Hire Report (DVR-17037-E)

Use this report to notify DVR of specific information for position(s) offered to consumers, and anticipated support needs or strategies.

Submit once following completion of activities and within 5 days of job hire offer.
Job Retention Report (DVR-17038-E)

Use this report when no Systematic Instruction is authorized to describe efforts to ensure a consumer maintains employment.

Submit Monthly when Retention is authorized.

The report is required only in the final month of Retention when SI is authorized.

Student Work-Based Learning

Report Name and Link Purpose of the Report Use and Submission Details
Job Development Plan and Monthly Report (DVR-18028-E)

Use this report to describe the activities with a consumer to help prepare and plan for future job development and to identify employment and/or internship opportunities for a consumer.

Submit initially following completion of activities and plan section.

Submit monthly to reflect job development activity.

Plan section reviewed every 90 days and section submitted for the month.

Job Hire Report (DVR-17037-E)

Use this report to notify DVR of specific information for position(s) offered to consumers, and anticipated support needs or strategies.

Submit once following completion of activities and within 5 days of job hire offer.
Job Retention Report (DVR-17038-E)

Use this report when no Systematic Instruction is authorized to describe provider efforts to ensure a consumer maintains employment. File at 30-day increments following hire or Retention initiation.

Submit Monthly when Retention is authorized.

The report is required only in the final month of Retention when SI is authorized.

Supported Employment

Report Name and Link Purpose of the Report Use and Submission Details
SE Career Profile Report (DVR-18033-E)

Use this report to describe the activities completed during the Career Profile Process.

Submit once following completion of activities.

Job Development Plan and Monthly Report (DVR-18028-E) Use this report to describe the activities with a consumer to help prepare and plan for future job development and to identify employment and/or internship opportunities for a consumer.

Submit initially following completion of activities and plan section.

Submit monthly to reflect job development activity.

Plan section reviewed every 90 days and section submitted for the month.

Job Hire Report (DVR-17037-E) Use this report to notify DVR of specific information for position(s) offered to consumers, and anticipated support needs or strategies. Submit once following completion of activities and within 5 days of job hire offer.
Job Retention Report (DVR-17038-E) Use this report when no Systematic Instruction is authorized to describe efforts to ensure a consumer maintains employment. Submit Monthly when Retention is authorized.
Job and Task Analysis and Systematic Instruction Report (DVR-18212-E)

Use the Job and Task Analysis portions of report to explain the anticipated support needs of a consumer and strategies to meet that need at the beginning of Employment or Internship/Temporary Work.

Once the consumer has begun working, use Service Summary section of the report to detail efforts to support the consumer.

Complete the Job and Task Analysis portion within 1 calendar week of consumer's start date and submit it as soon as possible.

Submit the report at the end of each month in which the service was provided.

Transition to LTS Report (DVR-18037-E)

Use this report to describe ongoing consumer support needs to continue as they transition to Long Term Care.

Submit this report following agreement between all parties on the plan for transitioning services Long Term Support.

Submit once following completion of activities.

Vocational Evaluation

Report Name and Link Purpose of the Report Use and Submission Details
Vocational Evaluation Assessment Report (DVR-18038-E)

Use this report to detail the activities that took place during the vocational evaluation. Submit this report within five days of the completion of the service.

Submit following completion of activities.

Resubmit, if necessary, with updates based on discussion during review.