RSA-113 Quarterly Cumulative Caseload Report

FORM RSA-113 OMB Approval No.: 1820-0013

Expiration Date: [Pending]

QUARTERLY CUMULATIVE CASELOAD REPORT

Rehabilitation Services Administration

OSERS/US DEPARTMENT OF EDUCATION

Fiscal Year

Period Covered

[ ] Blind [ ] Oct-Dec [ ] Oct-Jun

State [ ] General/Combined [ ] Oct-Mar [ ] Oct-Sep

Operated Under Order Of Selection During Period? [ ] Yes [ ] No

CASELOAD ITEMS	TOTAL NUMBER	NUMBER WITH SIGNFICANT DISABILITY
A. APPLICATIONS AND ELIGIBILITY
Applicants
1 Applicants On Hand October 1
2 Applicants, New This FY
3 Applicants At End Of Period (A1+A2-A5-A8-A12-D7)
4 Applicants In Trial Work/EE On Hand, October 1
5 Applicants In Trial Work/EE Referred This FY
6 Applicants In Trial Work/EE At End Of Period (A4+A5-A9-A13-D6)
Eligible Individuals On Order Of Selection (OOS) Waiting List
7 Individuals On OOS Waiting List On Hand October 1
8 Individuals On OOS Waiting List, New This FY From Application
9 Individuals On OOS Waiting List, New This FY From Trial Work/EE
10 Individuals On OOS Waiting List At End Of Period (A7+A8+A9-A14-D5)
Individuals Determined Eligible, Before Signed IPE
11 Eligible Individuals Before Signed IPE On Hand, October 1
12 Eligible Individuals Before Signed IPE, New This FY From Application
13 Eligible Individuals Before Signed IPE, New This FY From Trial Work/EE
14 Eligible Individuals Before Signed IPE, New This FY From OOS Waiting List
15 Eligible Individuals Before Signed IPE At End Of Period (A11+A12+A13+A14-B2-D3)
B. DEVELOPMENT OF INDIVIDUALIZED PLAN FOR EMPLOYMENT (IPE)
1 Individuals With Signed IPE, Before Receiving Services, On Hand October 1
2 Individuals With Signed IPE, Before Receiving Services, This FY
3 Individuals With Signed IPE, Before Receiving Services, At End Of Period (B1+B2-C2-D4)
C. SERVICE IMPLEMENTATION
1 Individuals Receiving Services, On Hand October 1
2 Individuals Receiving Services, Beginning This FY
3 Individuals Receiving Services At End Of Period (C1+C2-D1-D2)
D. OUTCOMES FOR INDIVIDUALS EXITING THE PROGRAM
1 Total Number Achieved Competitive and Integrated Employment or Supported Employment
2 Total Number Closed After An IPE Without An Employment Outcome
3 Total Number Closed After Eligibility, Before IPE Developed
4 Total Number Closed After An IPE In Noncompetitive and/or Nonintegrated Employment
5 Total Number Closed From OOS Waiting List
6 Total Number Closed From Trial Work Experience
7 Total Number Closed As An Applicant
8 Total Number Of Individuals Exiting The Program (D1+D2+D3+D4+D5+D6+D7)

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E-mail address ____________

Date Authorized Signature

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