PABSS Interent Interview (current screens)

PABSS Screenshots - Current Version.pdf

Protection and Advocacy for Beneficiaries of Social Security (PABSS)

PABSS Interent Interview (current screens)

OMB: 0960-0768

Document [pdf]
Download: pdf | pdf
PAtl SS Login

Protection and Advocacy of Beneficiaries of Social Security
(PABSS)

Please log in using your agency's assigned username and password

usernam;
~====;;;;

passwor11-_"i="'==:::::;-~_

I Log In 1

h tlps :llppr .p"bs sprr.com/rABSS/Login."spx ')RetumUrl~%2fpab"olo2 fmainmenu .aspx6/2 8/2006 10:3\ :4 \ AM

r ABSS Main Menu

Itreate New Reportj\Edit ReportjL...-_ _

-=-__

H

Logout

--:...-lL-_ _---:I

Welcome to the Social Security Web Report System, (PABSS)
To begin a new report, please select the Create New Report link. To continue on a report that has been started,
select the Edit Report link. To view or print submitted reports, select the View Completed Report link. To generate
reports, select the Report Generator link.

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _

hn ps:/lppr.pabssppr. COlll/p ab ssltn ainmenu. as.px6/28 /2006 10 :32 :U7 AM

-=ToQ

[ till Existing Report

Edit Demo Report
Name

I

Demo Report

I

.
~ Reporting Period

FY 2006 1ST Bi-Annual Report

Grant Award Numberl123456
....- - - - - - - - Report Prepared By
(Matt Hayden

I

Save & Continue

U

Add Attachments

II Cancel I
To

11Ilps :ll pp r. pabsspp r. comJPA B S S /A dvocac yG rou ps/ Edi t Ex i st mg .a sp x o/2 ~/200 6 10:32:4 5 AM

Enter Report Data

Logout
Part I - Quantitative Statistics" Part II - Narrative Reporting ..
Part I - Quantitative Statistics
Section A: Information and Referral

How many individuals received Information and Referral under the PABSS program
during the Report Period? (Do not count individuals more than once for this response.)

I

Individuals Receiving I&R

Previous Question

Next Question

Add Attachments

I

J

Validate Report
To

http" iippr.p abss ppr.comiPA BSSiAdvocacyGroup siQuestions.a spx6i28i2006 10:33:19 AM

Enter Report Data

Part I - Quantitative Statistics ~ Part II - Narrative Reporting ~
Part I • Quantitative Statistics
Section A: Information and Referral

How many Information and Referral requests were made under the PABSS program
during the report period? (Include alll&R requests, even if more than one for some
individuals. This number should equal or exceed Section A. 1.)

1'--__

Information and Referral Requests

.....

1"""-

-Previous Question

Next Question

Add Attachments

.I

Validate Report

I
To

hllps:/l ppr.pabssppr .com/PA BSSIAdvocac yGro opsiQ ueSlions.aspx6/2812006 10:33:41 AM

Enter Repo rt Data

Main

Logout

reate New Repo

Part I - Quantitative Statistics ~ Part II - Narrative Reporting ~
Part I - Quantitative Statistics
Section B: Individuals and Issue Area Service Requests/Workload Statistics

Individuals
a. How many individuals had open PABSS issue area service requests at the start of the report
period?
b. How many new PABSS individuals were added during the report period?
c. Total number of individuals with all issue area service requests that were closed during the

report period under the PABSS program

Previous Question

https://p pr.pabssp pr.com / PA BSS/A dvoca cyGroups/Ques tions.aspx6/28/20 06 10:34 :03 AM

Next Question

Add Attachments

I

I

B
Validate Report

Enter Report Darn

Main M

Logout


Part! - Quantitative Statistics ~ Part II - Narrative Reporting ~
Part I - Quantitative Statistics
Section B: Individuals and Issue Area Service Requests/Workload Statistics

Services
a. Total PABSS issue area service requests open at the start of the report period.
b. Number of new PABSS issue area service requests added during the report period?

c. Total number of issue area service requests closed during the report period?

Previous Question

Next Question

Add Attachments

Validate Report

To

hllps:!Ippr.pabssppr.com/PAa s sl AdvocacyGroups/Queslions.aspx6/28/2006 10:34:27 AM

Enter Report Data

Part I - Quantitative Statistics ~ Part II - Narrative Reporting ~
Part I - Quantitative Statistics
Section C: Individual Demographics

1. Please provide counts of individuals served by Gender:
a. Male
b. Female

Previous Question

J

I II
Save

Cancel t l-_N_e_x_t _Q_u_e_st_io_n_.1.....

hllps:llppr.pabssppr.COIll/PABSSIAdvocacyGroups/Quesliolls.asp,6/28/2006 10:34:4S AM

Add Attachments

J .L.

Validate Report
---:---:_....I

2. Please provide counts of individuals served by race (NOT
ETHNICITY):
a. American Indian or Alaska Native
b. Asian
d. Black or African American
e. Native Hawaiian or Other Pacific Islander
f. White
g. Unknown

Enter Report Data

reate New Repo

Part I - Quantitative Statistics ~ Part II - Narrative Reporting ~
Part I - Quantitative Statistics

Section C: Individual Demographics


3. Please provide counts of individuals receipted by Age Bracket:
a . 14 to 18
b. 19 to 21

c. 22 to 40
d. 41 to S9

e. 60 to 64

L...

Next Question .J.~~._I'l. .--.:..P.:.re:.v:.:.:io::u:.:s:....Q:.e
::.u ::s:.::ti.:.on
:..:...........U..:.::.:....:. ..LL..:.::;..:.:..:..;..U-~~..,.:.;.:.........::..-.:..._J

Add Attachments
Validate_...;,.-­
Report
- - ....J.•\ -............--

o

https.z/ppr.pabssppr.com/Pa SSSIAdvocncyGroups/QlIest;ons.nspx6/28/2006 10:35:45 AM

Enter Report Data

Logout

IPart I - Quantitative Statistics

~ IPart II - Narrative

Reporting

~

I

Part I . Quantitative Statistics
Section C: Individual Demographics

Please provide counts of individuals receipted by Beneficiary
Status.
a. SSI eligible
b. SSDI eligible
c. Dually eligible

________ _f:

Previous Question

Next Quest ion

Add Attachments

Validate Report

o

htlps:llp pr.pabsspp r.com/PA BSSIActvocacy Gro upsi Questions .aspx6/28/21m6 10:36 : 19 AM

Enter Report Data

Logout
Part I - Quantitative Statistics ~ Part II - Narrative Reporting ~
Part I • Quantitative Statistics

Section C: Individual Demographics


Please provide counts of individuals receipted by Primary Disability:
a. Absence of extremities
b. Autism
c. Auto-immune (lupus, thyroid, ALS, etc.)
d. Blindness (both eyes)

e.Cancer

f. Cerebral palsy
g. Deaf-blind
h. Deafness

i, Diabetes

j. Digestive disorders (chronic pancreatitis, esophageal stricture, fistulae, chronic liver, etc.)
k. Epilepsy

I. Genitourinary conditions (kidney, prostate, etc.)
m. Hard of Hearing (not deaf)
n. Heart and other circulatory problems including cardiovascular
o. HIV/AIDS
p. Mental illness (diagnosis according to DSM-IV)
q. Mental retardation
r. Multiple sclerosis
s. Muscular dystrophy
t. Muscular / Skeletal impairment (arthritis, fibromyalgia, osteogenesis imperfecta, osteomyelitis,

etc.)
u. Neurological disorders (brain tumors, convulsive disorders, Parkinson, etc.)
v. other emotional/behavioral (Provide detail)

Add Explanation


I

Explanations

There are no data records to display.

w. Other intellectual such as ADD! ADHD (Provide detail)
Add Explanation

I

Explanations


There are no data records to display.

x. Physical/orthopedic including spinal cord injuries, paraplegia, quadriplegia, back problems, etc. 1,-·

httpS:llppr.pabssppr.com/PABSS/Advocacyflr oups/Questic ns.aspx (I of 2)6/28/2006 10:37:25 AM

_

Enter Report Data

y. Respiratory disorders (emphysema, asthma, pulmonary hypertension, cystic fibrosis, etc.)


z, Specific learning disabilities (SLD)

aa. Speech impairment

bb, Spina bifida


cc. Substance abuse (alcohol or drugs)

dd. Tourette syndrome

ee. Traumatic brain injury (TBI)


ft. Visual Impairment (not blind)


99· Disability not known/Other than Above (Specify)

Add Explanation

I

Explanations


There are no data records to display.


Previous Quest ion

Next Question

Add Attachments

To

hllps:l/ppr .pabssppr.com/ PABSS/AdvocacyGroup siQuestions.aspx (2 0(2 )6128/2006 10 :37:25 AM

Enter Report Data

Part I - Quantitative Statist ics ·~ Part II - Narrative Reporting ~
Part I . Quantitative Statistics

Section 0: Major Source of Concern


Please Provide counts of all PABSS issue are service request receipts by major source
of individual's concern for the current report period:
1. State Vocational Rehab Agency (public VR program)

2. Employment Networks (SSA contractor)

3. Agencies other than 1. or 2. above
4. Employment discrimination - hire, fire, promotion

5. Employment wages and benefits
6. Housing
7. Healthcare (not 5 above)

8. Insufficient/improper benefits planning
9. Transition services (Student beneficiary between 14-18 (or under age 22) engaging/needing a

transition plan)

10. Post Secondary accommodation
11. Transportation

12. Social Security benefits cessation based on SGA (including CDR's) - not Overpayment
13. Benefits Questions/Work Incentives - Not 12 or 14

14. Work Related Overpayment
15. other (IF SELECTED MUST SPECIFY)
Add Explanation

I


Explanations

--­ - -------­
There are no data records to display.

Previous Question

II Save II

Cancel

\1

Next Question

II

Add Attachments

LI

Validate Report

To

https.z/ppr.pabssppr.com/Pa BSS/Act vocacyGroups/Qu cslions.aspx6/28/2006 10:37 :52 AM

En te r Rep ort Dat a

Part I - Quantitative Statistics ~ Part II - Narrative Reporting ~
Part I • Quantitative Statistics
Section E: Closed Issue Area Service Requests

What was the problem/sub-problem area?
a. [AT] Assistive Technology
b. [Education] Transition school to work
c. [Employment] Discrimination in employment benefits
d. [Employment] Discrimination in hiring
e. [Employment] Unlawful termination / firing

f. [Employment] other employment discrimination
g. [Employment] Reasonable accommodation - not d, e, or f from above
h. [Employment] Service provider issues - not c-g above
i. [Employment] Wage and hour issues

j. [Financial Entitlements] SSI: Overpayments based on work issues


k, [Financial Entitlements] SSDI: Overpayments based on work issues

I. [Financial Entitlements] (other) - Specify

Add Explanation


I

Explanations
--_. _.......-..... _ .
There are no data records to display.

- - - - _. ­

-

I
I

m, [Healthcare] Medicaid only issues
n. [Healthcare] Medicare/Medicaid issues

o, [Healthcare] Medicare only issues
p. [Healthcare] Private Insurance Issues
q. [Housing] Accommodations in housing
r. [Housing] Subsidized housing/Section 8

s, [Housing] Rental termination ­ not q .
t. [Housing] Other - Specify
Add Explanation

I

Explanations
..

There are no data records to display.
u, [Childcare]

v. [Rehab services] Related to State VR
w. [Rehab Services] Related to Employment Network (EN)
x. [Rehab Services] Related to Agencies other than State VR or Employment Network (EN)

hu ps.z/pp r.pa bssppr .com/Pa BSS/Ad vocac yGr ou ps/Q uest lOns .asp x (I of 2)6/28 12006 10:38:26 AM

I

Enter Report Data

y. [Post-Secondary Ed] Accessibility

z, [Post-Secondary Ed] Funding issues
aa. [Post-Secondary Ed] Grievance Against College - Not y or z above
bb. [Post-Secondary Ed] Other - Specify
.Add Explanation

I

Explanations

There are no data records to display.

_.­ -

__

- - - - - _. ._ - - -

cc. [Services] Personal assistance - not Employment

dd. [Transportation]

ee. [Benefits Planning] referral! access to BPAO services


ft. [Other] (IF SELECTED MUST SPECIFY)

Add Explanat ion

I

Explanations
-

-­

-

---­ - - ­ - - - ­ - - - - - - - - - ­

There are no data records to display.

Previous Question

https://ppr.p abss ppr. com /P ABSS /Ad vocac yGr oups/Qu estions .asp x (2 of 2 )6/2 812006 J 0:38 :26 AM

Next Question

Add Attachme nts

Validate Report

Enter Report Data

Part I - Quantitative Statistics ~ Part II - Narrative Reporting ~
Part I - Quantitative Statistics
Section E: Closed Issue Area Service Requests

What was the reason for closing the individual's issue area service request?
a. Issue Resolved in Individual's Favor

...----....

b. Issue Partially Resolved in Individual's Favor
c. Issue Lacked Legal Merit
d. Individual decided not to pursue resolution or Individual Withdrew Complaint (Not e-g below)
e. Other Representation Obtained (Individual found other representation)
f. Individual Not Responsive to Agency / Individual refused to cooperate with P&A
g. Services Not Needed Due to lost contact, Death, Relocation, etc.
h. Advocacy efforts/appeals were unsuccessful (Issue not resolved in Individual's Favor)
i. Other (IF SELECTED MUST SPECIFY)
Add Explanation

I


Explanations


There are no data records to display.


Previous Question

htlpd /ppr.pabss ppr.com/ PA BSS/Ad vocacyGroups/QueSlio ns.asp x6/28/200 6 10:38:47 AM

Next Question

Add Attachments

Validate Report

Enter Report Data

IPart I - Quantitative Statistics .. IPart II - Narrative Reporting ..

I

Part I • Quantitative Statistics
Section E: Closed Issue Area Service Requests

What was the highest intervention strategy used?
a. Short Term/Technical assistance
b. Informal Resolution
c. Investigation/ Monitoring
d. Negotiation
e. Mediation / Alternative Dispute Resolution
f. Administrative Remedies
g. Legal remedy / Litigation
h. Class Action Suits
i. Systemic / Policy activities

Previous Question

Next Question

Add Attachments

Validate Report

To

hltps:l/ppr.pabssppr .com/ PABSSIAd vocacyGroupsiQues\ions .a spx6/2~/2006 J0 :39:' II AM

Enter Repo rt Data

lew Completed Repo

Part I - Quantitative Statistics. Part II - Narrative Reporting.
Part I • Quantitative Statistics

Section E: Closed Issue Area Service Requests


As a result of P&A intervention, the following major outcome was achieved:
. - - -.....

a. Individual gained / maintained access to services including those of VR, EN or other agency
b. Individual obtained employment
c. Individual regained employment
d. Individual maintained employment
e. Individual advanced in employment
f. Individual's employment opportunities increased
g. Individual obtained an increase in salary and/or benefits
h. Validity of discrimination complaint was upheld
i, Overpayment situation addressed (it doesn't matter if it was waived or the efforts weren't

successful)

j. Individual acquired knowledge concerning his/her rights

k, Outcome information is not available
I. Other outcome (IF SELECTED MUST SPECIFY)
Add Explanation

I

Explanations
.-

- - - - -- - - - - - - - - - -- - - - - -- - - - - - - -- - - - - - ­

There are no data records to display.

I.

Previous Quest ion

Next Question

Add Attachments

Validate Report

To

hups.z/ppr.pab ssppr.com /Pa BSSIAdvocacyGroupsiQueS lio ns.as px612812006 10:39 :31 AM

Enter Report Data

!part I - Quantitative Statistics

~ Ipart II - Narrative Reporting ~ I

Part II - Narrative Reporting
Section A: Description of Progress and Status Update

Please provide a brief overview of overall project status, staff changes, staff training or
other major developments with regard to the PABSS program. This could include
information about boards and committees where decisions are made concerning
disability service delivery and local policy.
Progress and Status Update

"'---

---',J..-_p_re
_v_iO
_U_S_Q_u_e_st_io_n---..J,,1Save

II

Cancel

I

Next Question

Add Attachments

I

Validate Report

o

hllps:llppr.pahssppr .co mfPA BSSIAd vocacyGroups/Q ueslions.asp,6/2812006 10:39:49 AM

Enter Report Data

Logout

Ipart I - Quantitative Statistics

~ Ipart II - Narrative Reporting ~ I

Part II - Narrative Reporting
Section B: Detail of Actions Taken on the Project

Issue Area Service Requests Summaries: [Please provide summaries of three Issues!
Service Requests undertaken as part of the PABSS project. Indicate clearly the issue or
problem, the PABSS intervention, and the results if known]
Issue Area Service Requests Summaries

Previous Question

Next Question

Add Attachments

I

Validate Report

o

hllps:l/ppr.pabssppr.com/PAB551AdvocacyGroups/Questions.aspx6/28/2006 10:40:06 AM

EUler Report Data

reate New Repo

Ipart I - Quant itative Statistics

~ IPart II - Narrative Reporting ~ I

Part II - Narrative Reporting

.
Section B : Detail of Actions Taken on the Project

Outreach Statistics:

B

Total Number of Outreach/Presentations
Total Number of Persons Reached by Outreach I Presentation Events

Previous Question

https:llppr.pabssppr.co m/PAB SS/Ad vocacyG rollp>lQucstiolls.aspx6/28/2006 10:40:26 AM

Next Question

Add Attachments

Validate Report

Enter Report Data

Part I - Quantitative Statistics ~ Part II - Narrative Reporting ~
Part II - Narrative Reporting
Section B: Detail of Actions Taken on the Project

Other Information Dissemination Activities: (Number of Instances)
1. Radio/TV appearances by PABSSstaff
2. Newspaper/Magazine/Journal articles prepared by staff
3. PSAs/videos/films aired by the Agency

4. Reports disseminated
5. Publications/ Booklets/ Brochures disseminated
6. Number of Website hits

7.	 Other media activities (IF SELECTED MUST SPECIFY)

Add Explanation


I

Explanations


There are no data records to display.


Previous Question

Next Question

Add Attachments

Validate Report

To

htlps:llp pr.pabssppr.com/ PA BSSIAdvocacyG roup, /Q uestions.aspx6/28/2006 t 0:40 :47 AM

Enter Report Data

Main Men

[Part I - Quantitative Statistics

~ Ipart II - Narrative Reporting ~ I

Part II - Narrati ve Reporting
Section B: Detail of Actions Taken on the Project

Outreach Narrative: [Describe the agency's outreach efforts. Describe the trainings
presented by the staff including information about the topics covered, the purpose of
the training, and a description of the attendees. Describe media events, informational
materials developed or other activities undertaken as part of the PAB55 project.]
Outreach Narrative

Previous Question

hu ps:llppr.pabssppr.com/ PABSSIAdvocacyGroups/Ques liuns.aspx6l28 /20Q6 10:4 1:01 AM

Next Question

Add Attachments

Validate Report

Ente r Repo rt Data

Ipart I - Quantitative Statistics

~ Ipart II - Narrative Reporting ~ I

Part II - Na rrative Reporting
Section C: Problems Encountered and Steps Taken to Resolve Problems

Problems encountered and steps taken to resolve problems: [Please provide detail
information about problems encountered in implementing or administering the PABSS
program and actions you have taken to resolve the problems you encountered.]
Problems encountered and steps taken to resolve problems

Previous Question

Next Question

Add Attachments

Validate Report

To

hup s:!/p pr.pab ssp pr.com/P ABSS/Ad vocacyGrou ps/Q ueSlions.asp x6/28/2006 10:41:20 AM

Enter Re port Data

reate New Repo

Ipart I

~>Quantitative Statistics ~ !part II - Narrative

Reporting

~I

Part II - Narrative Reporting
Section D: Planned Future Activities

Planned activities: [Please provide activities you plan to undertake to further the
objectives of the PABSS project.]
Planned activities

Previous Quest ion

Next Question

Add Attachments

Validate Report

To

htlp>:l,'ppr.pa os;ppr .com IPA BSS/Ad voca cyGroupsIQueSlions.aspx6/2 8/2006 10:41:40 AM

Enter Report Data

Logout

Ipart I - Quantitative Statistics

~ Ipart II - Narrative Reporting ~ I

Part II - Narrative Reporting
Section E: Diversification Activities

Diversification activities: [Please provide a description of activities undertaken to
address the needs of individuals with disabilities from diverse ethnic and racial
communities.]
Diversification activities

Previous Question

Next Question

Add Attachments

Validate Report

To

hltps:llppr.pabsspp r.comIP AB SS/Ad vocacyGro upS/Qucsti ons.aspx6/28/2006 l OA I:58 AM

Privacy Act Statement
SSA is required to collect this information under section 1150 of the Social Security Act
(the Act). We use the information to manage the Protection and Advocacy for
Beneficiaries of Social Security programs, with particular emphasis on contract
administration, budgeting, and training.
There are certain situations authorized by Federal law in which SSA may release the
information you give us through this Project. For example, we release the information to
a congressional office in response to an inquiry that office may make at your request.
Explanations about these and other reasons why information you provide us may be
used or given out are available in Social Security Offices. If you want to learn more
about this, contact any Social Security Office.

Paperwork Reduction Act Statement
Paperwork Reduction Act Statement - This information collection meets the
requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction
Act of 1995. You do not need to answer these questions unless we display a valid Office
of Management and Budget control number. We estimate that it will take about 60
minutes to read the instructions, gather the facts, and answer the questions. You may send
comments on our time estimate above to: SSA, 6401 Security Blvd, Baltimore, MD
21235-6401. Send only comments relating to our time estimate to this address, not the
completed form. See Revised Paperwork
Reduction Act Statement

SSA will insert the following revised PRA Statement into the form at its
next scheduled reprinting:
Paperwork Reduction Act Statement - This information collection meets the
requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction
Act of 1995. You do not need to answer these questions unless we display a valid Office
of Management and Budget control number. We estimate that it will take about 60
minutes to read the instructions, gather the facts, and answer the questions. Send only
comments relating to our time estimate above to: SSA, 6401 Security Blvd, Baltimore,
MD 21235-6401.


File Typeapplication/pdf
File Modified2013-08-23
File Created2007-08-16

© 2024 OMB.report | Privacy Policy