Vocational Rehabilitation Service Forms

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NOTE: On September 17, 2018, all form names in this list were updated to use the "VR" prefix instead of "DARS." The form contents and form file names will change over time as the form catalog items are reviewed and updated. Questions about VR forms can be emailed to VR Services Manual Support.

Form Form Title Word Excel PDF Submit Online Instr Revised
VR1020 TWC Substitute W-9 and Direct Deposit Form     TWC Substitute W-9 and Direct Deposit Form, VR1020 - PDF version   TWC Substitute W-9 and Direct Deposit Form, VR1020INST - Instruction Sheet 06/27/2018
VR1020-S Forma W-9 Sustituta y de Depósito Directo del TWC     Forma W-9 sustituta y de depósito directo del TWC, VR1020-S - PDF version   Forma W-9 sustituta y de depósito directo del TWC, VR1020INST-S - Instruction Sheet 09/01/2016
VR1021 Consumer or Parent Information and Direct Deposit     Consumer or Parent Information and Direct Deposit, VR1021 - PDF version   Consumer or Parent Information and Direct Deposit, VR1021 - Instruction Sheet 06/01/2017
VR1021-S Información del Cliente o de los Padres/Guardas y de Depósito Directo     Información del cliente o de los padres/guardas y de depósito directo, VR1021-S - PDF version   Información del cliente o de los padres/guardas y de depósito directo, VR1021INST-S - Instruction Sheet 09/01/2016
VR1050 Ticket to Work Partnership Plus—Employment Advancement Payment Ticket to Work Partnership Plus - Employment Advancement Payment, VR1050 - Word version       Ticket to Work Partnership Plus - Employment Advancement Payment, VR1050INST - Instruction Sheet 10/01/2017
VR1211 Provider Application Provider Application, VR1211 - Word version         10/01/2017
VR1305 Child Support Certification Child Support Certification, VR1305 - Word version       Child Support Certification, VR1305 - Instruction Sheet 11/01/2017
VR1487 Designation of Applicant or Customer Representative Designation of Applicant or Customer Representative, VR1487 - Word version         10/01/2017
VR1487-S Designación del Representante del Solicitante o Cliente Designación del Representante del Solicitante o Cliente, VR1487-S - Word version         10/01/2017
VR1505 Request for Due-Process Hearing and/or Mediation Request for Due-Process Hearing and/or Mediation, VR1505 - Word version         08/01/2019
VR1505-S Solicitud para audiencia de proceso debido y/o mediación Solicitud para audiencia de proceso debido y/o mediación, VR1505-S - Word version         08/01/2019
VR1512 Benefits and Work Incentives Planning Referral Benefits and Work Incentives Planning Referral, VR1512 - Word version         08/01/2019
VR1600 Work Experience Services Referral Work Experience Services Referral, VR1600 - Word version         10/01/2017
VR1601 Work Experience Plan Work Experience Plan, VR1601 - Word version         10/01/2017
VR1602 Work Experience Placement Report Work Experience Placement Report, VR1602 - Word version         10/01/2017
VR1603 Work Experience Monitoring Report Work Experience Monitoring Report, VR1603 - Word version         10/01/2017
VR1604 Work Experience Training Report Work Experience Training Report, VR1604 - Word version         07/30/2018
VR1609 On-the-Job Training Worksheet On-the-Job Training Worksheet, VR1609 - Word version         01/01/2018
VR1628 Attendant Care Reimbursement—Request for Rate Exception     Attendant Care Reimbursement - Request for Rate Exception, VR1628 - PDF version     07/01/2015
VR1640 Referral for Supported Employment Services Referral for Supported Employment Services, VR1640 - Word version         06/03/2019
VR1641 Supported Employment Assessment Report (SEA) Supported Employment Assessment Report (S E A), VR1641 - Word version         06/03/2019
VR1642 Supported Employment Services Plan 1 Supported Employment Services Plan - 1, VR1642 - Word version         06/03/2019
VR1643 Supported Employment Services Plan 2 - Placement, Job Analysis, and Training Plan Supported Employment Services Plan 2 - Placement, Job Analysis, and Training Plan, VR1643 - Word version         06/03/2019
VR1644 Supported Employment Services Time Tracking Log Supported Employment Services Time Tracking Log, VR1644 - Word version         06/03/2019
VR1645 Supported Employment Training and Progress Report Supported Employment Training and Progress Report, VR1645 - Word version         06/03/2019
VR1646 Supported Employment Job Stability Justification Summary Supported Employment Job Stability Justification Summary, VR1646 - Word version         06/03/2019
VR1647 Supported Employment Services Closure Summary Supported Employment Services Closure Summary, VR1647 - Word version         06/03/2019
VR1800 Self-Employment Referral Self-Employment Referral, VR1800 - Word version         10/01/2017
VR1801 Customer Profile and Self-Employment Exploration Customer Profile and Self-Employment Exploration, VR1801 - Word version         11/01/2018
VR1802 Concept Development and Feasibility Study Concept Development and Feasibility Study, VR1802 - Word version         10/01/2019
VR1803 Self-Employment Simple Business Plan Self-Employment Simple Business Plan, VR1803 - Word version         10/01/2017
VR1804 Self-Employment Comprehensive Business Plan Self-Employment Comprehensive Business Plan, VR1804 - Word version         10/01/2017
VR1805-1 Self-Employment Financial Projections Spreadsheet (Statutory Blindness)   Self-Employment Financial Projections Spreadsheet (Statutory Blindness), VR1805-1 - Excel version       12/01/2017
VR1805-2 Self-Employment Financial Projections Spreadsheet   Self-Employment Financial Projections Spreadsheet, VR1805-2 - Excel version       12/01/2017
VR1806 Self-Employment Financial Actual Spreadsheet   Self-Employment Financial Actual Spreadsheet, VR1806 - Excel version       10/01/2017
VR1808 Supported Self-Employment Assessment (SSEA) Supported Self-Employment Assessment (SSEA), VR1808 - Word version         10/01/2017
VR1809 Supported Self-Employment Concept Development Supported Self-Employment Concept Development, VR1809 - Word version         10/01/2017
VR1810 Supported Self-Employment Feasibility Study Supported Self-Employment Feasibility Study, VR1810 - Word version         10/01/2017
VR1811 Supported Self-Employment Services Plan (SSESP) and Benchmark Report Supported Self-Employment Services Plan (SSESP) and Benchmark Report, VR1811 - Word version         10/01/2017
VR1812 Supported Self-Employment Business Plan Support Summary Report Supported Self-Employment Business Plan Support Summary Report, VR1812 - Word version         10/01/2017
VR1813 Supported Self-Employment Business Plan Supported Self-Employment Business Plan, VR1813 - Word version         10/01/2017
VR1814 Supported Self-Employment Support Summary (SSE-SS) Supported Self-Employment Support Summary (SSE-SS), VR1814 - Word version         10/01/2017
VR1815 Certified Business Technical Assistance Consultant (CBTAC) Support Summary Report Certified Business Technical Assistance Consultant (CBTAC) Support Summary Report, VR1815 - Word version         10/01/2017
VR1820 Request to Receive Pre-Employment Transition Services Request to Receive Pre-Employment Transition Services, VR1820 - Word version         03/01/2018
VR1820-S Solicitud para recibir servicios de transición previos al empleo Solicitud para recibir servicios de transición previos al empleo, VR1820-S - Word version         03/01/2018
VR1821 Pre-Employment Transition Services (Pre-ETS) Proposal Pre-Employment Transition Services (Pre-ETS) Proposal, VR1821 - Word version         10/01/2017
VR1822 Pre-Employment Transition Services (Pre-ETS) Pre- and Post-Assessment Pre-Employment Transition Services (Pre-ETS) Pre- and Post-Assessment, VR1822 - Word version         10/01/2017
VR1823 Pre-Employment Transition Services (Pre-ETS) Progress Report Pre-Employment Transition Services (Pre-ETS) Progress Report, VR1823 - Word version         07/01/2019
VR1824 Referral for Contracted Pre-Employment Transition Services (Pre-ETS) Services Referral for Contracted Pre-Employment Transition Services (Pre-ETS) Services, VR1824 - Word version         07/01/2019
VR1825 Pre-ETS Curriculum Checklist Pre-Employment Transition Services (Pre-ETS) Curriculum Checklist, VR1825 - Word version         07/01/2019
VR1836 Vocational Evaluation Referral Vocational Evaluation Referral, VR1836 - Word version         01/02/2019
VR1837 Report for Vocational Evaluation Report for Vocational Evaluation, VR1837 - Word version         01/02/2019
VR1838 Situational Assessment and Work Sample Report Situational Assessment and Work Sample Report, VR1838 - Word version         01/02/2019
VR1840 Job Placement Services - Referral Job Placement Services - Referral, VR1840 - Word version         07/23/2019
VR1841 Non-Bundled Job Placement Services Data Sheet, Application, and Résumé Training Non-Bundled Job Placement Services Data Sheet, Application, and Résumé Training, VR1841 - Word version         07/01/2019
VR1842 Non-Bundled Job Placement Services Interview Training Report Non-Bundled Job Placement Services Interview Training Report, VR1842 - Word version         07/01/2019
VR1845A Bundled Job Placement Services Placement Plan Part A Bundled Job Placement Services Placement Plan Part A, VR1845A - Word version         07/01/2019
VR1845B Bundled Job Placement Services Plan Part B and Status Report Bundled Job Placement Services Plan Part B and Status Report, VR1845B - Word version         07/01/2019
VR1846 Bundled Job Placement Services Benchmark A Training Report Bundled Job Placement Services Benchmark A Training Report, VR1846 - Word version         07/01/2019
VR1850 Employment Data Sheet Employment Data Sheet, VR1850 - Word version         10/01/2017
VR1877A Environmental Work Assessment Report Part A Environmental Work Assessment Report Part A, VR1877A - Word version       Environmental Work Assessment Report Part A, VR1877A - Instruction Sheet 10/01/2017
VR1877B Environmental Work Assessment Report Part B   Environmental Work Assessment Report Part B, VR1877B - Excel version       11/01/2017
VR1877C Environment Work Assessment Signature Page Part C Environment Work Assessment Signature Page Part C, VR1877C - Word version         10/01/2017
VR1878 Environmental Work Assessment Time Log Environmental Work Assessment Time Log, VR1878 - Word version         10/01/2017
VR1879 Referral Form for Services for Neurodevelopmental Disorders Referral Form for Services for Neurodevelopmental Disorders, VR1879 - Word version         11/01/2018
VR1880 Autism Spectrum Disorder Supports Plan Autism Spectrum Disorder Supports Plan, VR1880 - Word version         11/01/2018
VR1881 Autism Spectrum Disorder Supports Time Log and Progress Report Autism Spectrum Disorder Supports Time Log and Progress Report, VR1881 - Word version   Autism Spectrum Disorder Supports Time Log and Progress Report, VR1881 - PDF version     10/01/2017
VR1882 Autism Service Premium Report Autism Service Premium Report, VR1882 - Word version         04/01/2019
VR1884 Assistive Technology Services for Sight-Related Disabilities Referral Assistive Technology Services for Sight-Related Disabilities Referral, VR1884 - Word version         10/01/2018
VR1886 Assistive Technology Evaluation Assistive Technology Evaluation, VR1886 - Word version   Assistive Technology Evaluation, VR1886 - PDF version     10/01/2017
VR1888 Assistive Technology Training Results Assistive Technology Training Results, VR1888 - Word version   Assistive Technology Training Results, VR1888 - PDF version     10/01/2017
VR2006E Interagency Eye Examination Report Interagency Eye Examination Report, VR2006E - Word version         10/01/2017
VR2305 Certificate of Medical Necessity Physician Order for Blood Pressure Monitor Physician Order for Blood Pressure Monitor, VR2305 - Word version         09/03/2019
VR2608 Case Review—Older Individuals Who Are Blind (OIB) Case Review—Older Individuals Who Are Blind (OIB), VR2608 - Word version         10/01/2017
VR2868 Assistive Technology Training Report Assistive Technology Training Report, VR2868 - Word version         11/01/2017
VR2883 Diabetes Self-Management Education Referral Form Diabetes Self-Management Education Referral Form, VR2883 - Word version         10/01/2017
VR2884 Diabetes Self-Management Educator Notes Diabetes Self-Management Educator Notes, VR2884 - Word version         06/03/2019
VR2888 Diabetes Self-Management Education Assessment Diabetes Self-Management Education Assessment, VR2888 - Word version         06/03/2019
VR2889 Diabetes Self-Management Education Services - Adaptive Diabetes Equipment Receipt Diabetes Self-Management Education Services - Adaptive Diabetes Equipment Receipt, VR2889 - Word version         06/03/2019
VR2891 ILS-OIB Customer Services Progress Report ILS-OIB Customer Services Progress Report, VR2891 - Word version         10/01/2017
VR2894 Orientation and Mobility Assessment Consumer Services Report: O&M Assessment, VR2894 - Word version         10/01/2017
VR2896 Orientation and Mobility Training Orientation and Mobility Training, VR2896 - Word version         10/01/2017
VR2897 Orientation and Mobility Referral Orientation and Mobility Referral, VR2897 - Word version         10/01/2017
VR2900 Diabetes Self-Management Education Post Training Assessment Diabetes Self-Management Education Post Training Assessment, VR2900 - Word version         06/03/2019
VR2901 Diabetes Self-Management Education Pre- and Post-Assessment Diabetes Self-Management Education Pre- and Postassessment, VR2901 - Word version         06/03/2019
VR2902 Assistive Technology Training Baseline Assessments     Assistive Technology Training: Baseline Assessments, VR2902 - PDF version     02/01/2014
VR2922 Orientation and Mobility Weekly Internship Observation Orientation and Mobility Weekly Internship Observation, VR2922 - Word version         10/01/2017
VR2923 Orientation and Mobility Internship Performance Evaluation Orientation and Mobility Internship Performance Evaluation, VR2923 - Word version         10/01/2017
VR2954 Comprehensive Assessment for ILS-OIB Program Comprehensive Assessment for ILS-OIB Program, VR2954 - Word version         10/01/2017
VR3100 General Physical Examination Report General Physical Examination Report, VR3100 - Word version         10/01/2017
VR3101 Consultant Review Consultant Review, VR3101 - Word version         03/26/2018
VR3102 Pulmonary Evaluation Report Pulmonary Evaluation Report, VR3102 - Word version   Pulmonary Evaluation Report, VR3102 - PDF version     11/01/2017
VR3103 Cardiac Evaluation Report Cardiac Evaluation Report, VR3103 - Word version   Cardiac Evaluation Report, VR3103 - PDF version   Cardiac Evaluation Report, VR3103 - Instruction Sheet 11/01/2017
VR3105A Hearing Evaluation Report: Customer Questionnaire Hearing Evaluation Report Customer Questionnaire, VR3105A - Word version         10/01/2017
VR3105B Hearing Evaluation Report: Otological Examination Hearing Evaluation Report Otological Report, VR3105B - Word version         10/01/2017
VR3105C Hearing Evaluation Report: Audiometric Examination Hearing Evaluation Report Audiometric Examination, VR3105C - Word version         10/01/2017
VR3105D Hearing Evaluation Report: Hearing Aid Recommendations Hearing Evaluation Report Hearing Aid Recommendations, VR3105D - Word version         10/01/2017
VR3105E Hearing Aid Fitting and Post-Fitting Report Hearing Aid Fitting and Post-Fitting Report, VR3105E - Word version         12/01/2017
VR3106 Work Restriction Checklist Work Restriction Checklist, VR3106 - Word version       Work Restriction Checklist, VR3106 - Instruction Sheet 11/01/2017
VR3108 Dental Report Dental Report, VR3108 - Word version   Dental Report, VR3108 - PDF version   Dental Report, VR3108 - Instruction Sheet 11/01/2017
VR3110 Surgery and Treatment Recommendations Surgery and Treatment Recommendations, VR3110 - Word version         08/27/2018
VR3111 End-Stage Renal Disease Evaluation End-Stage Renal Disease Evaluation, VR3111 - Word version   End-Stage Renal Disease Evaluation, VR3111 - PDF version   End-Stage Renal Disease Evaluation, VR3111 - Instruction Sheet 11/01/2017
VR3112 Cancer Disability Medical Report Cancer Disability Medical Report, VR3112 - Word version   Cancer Disability Medical Report, VR3112 - PDF version   Cancer Disability Medical Report, VR3112 - Instruction Sheet 11/01/2017
VR3118 Hospital/Medical Service Areas Hospital/Medical Service Areas, VR3118 - Word version         01/01/2018
VR3121 Referral for Work Readiness Services Referral for Work Readiness Services, VR3121 - Word version         12/03/2018
VR3122 Vocational Adjustment Training (VAT): Explore the "You" in Work Vocational Adjustment Training (VAT): Explore the "You" in Work, VR3122 - Word version         10/01/2017
VR3123 Vocational Adjustment Training (VAT): Soft Skills for Work Success Vocational Adjustment Training (VAT): Soft Skills for Work Success, VR3123 - Word version         10/01/2017
VR3124 Vocational Adjustment Training (VAT): Soft Skills to Pay the Bills Vocational Adjustment Training (VAT): Soft Skills to Pay the Bills, VR3124 - Word version         10/01/2017
VR3125 Vocational Adjustment Training (VAT): Entering the World of Work Vocational Adjustment Training (VAT): Entering the World of Work, VR3125 - Word version         10/01/2017
VR3126 Vocational Adjustment Training (VAT): Job Search Training Vocational Adjustment Training (VAT): Job Search Training, VR3126 - Word version         06/04/2018
VR3132 Vocational Adjustment Training (VAT): Disability Disclosure Training Vocational Adjustment Training (VAT): Disability Disclosure Training, VR3132 - Word version         10/01/2017
VR3133 Vocational Adjustment Training (VAT): Money Smart Vocational Adjustment Training (VAT): Money Smart, VR3133 - Word version         06/03/2019
VR3134 Vocational Adjustment Training (VAT): Public Transportation Training Vocational Adjustment Training (VAT): Public Transportation Training, VR3134 - Word version         10/01/2017
VR3135A Vocational Adjustment Training Specialized Evaluation Vocational Adjustment Training Specialized Evaluation, VR3135A - Word version         10/01/2017
VR3135B Vocational Training Specialized Training Plan Vocational Training Specialized Training Plan, VR3135B - Word version         10/01/2017
VR3136 Vocational Adjustment Training Specialized Progress Report Vocational Adjustment Training Specialized Progress Report, VR3136 - Word version         10/01/2017
VR3137A Personal Social Adjustment Training and Work Adjustment Training Evaluation Personal Social Adjustment Training and Work Adjustment Training Evaluation, VR3137A - Word version         04/01/2019
VR3137B Personal Social Adjustment and Work Adjustment Training Plan Personal Social Adjustment and Work Adjustment Training Plan, VR3137B - Word version         10/01/2017
VR3138 Personal Social Adjustment Training and Work Adjustment Training Report Personal Social Adjustment Training and Work Adjustment Training Report, VR3138 - Word version         04/01/2019
VR3314 Job Skills Training Referral Job Skills Training Referral, VR3314 - Word version         07/01/2019
VR3315 Job Skills Training Progress Report Job Skills Training Progress Report, VR3315 - Word version         10/01/2017
VR3316 On-the-Job Training Progress Report On-the-Job Training Progress Report, VR3316 - Word version         11/01/2017
VR3321 Proprietary School Training Information Proprietary School Training Information, VR3321 - Word version         11/01/2017
VR3370 Project SEARCH Asset Discovery Report Project SEARCH Asset Discovery Report, VR3370 - Word version   Project SEARCH Asset Discovery Report, VR3370 - PDF version     10/01/2017
VR3371 Project SEARCH Progress Report Project SEARCH Progress Report, VR3371 - Word version         10/01/2017
VR3372 Project SEARCH Internship Report Project SEARCH Internship Report, VR3372 - Word version         10/01/2017
VR3373 Project SEARCH Job Placement Services Plan Project SEARCH Job Placement Services Plan, VR3373 - Word version         10/01/2017
VR3374 Project SEARCH Placement Report Project SEARCH Placement Report, VR3374 - Word version         10/01/2017
VR3375 Project SEARCH Extended Services, Retention Services, and Long-Term Support Services Summary Report Project SEARCH Extended Services, Retention Services, and Long-Term Support Services Summary Report, VR3375 - Word version         10/01/2017
VR3380 Referral for Wellness Recovery Action Plan (WRAP) or Supportive Residential Services (SRS) Referral for Wellness Recovery Action Plan (WRAP) or Supportive Residential Services (SRS), VR3380 - Word version         10/01/2017
VR3381 Wellness Recovery Action Plan (WRAP) Services Summary and Recommendations Wellness Recovery Action Plan (WRAP) Services Summary and Recommendations, VR3381 - Word version   Wellness Recovery Action Plan (WRAP) Services Summary and Recommendations, VR3381 - PDF version     10/01/2017
VR3384 Supportive Residential Services (SRS) Progress Report Supportive Residential Services (SRS) Progress Report, VR3384 - Word version         10/01/2017
VR3386 Intensive Work Preparation and Life Skills Training Referral     Intensive Work Preparation and Life Skills Training Referral, VR3386 - PDF version     11/01/2017
VR3387 Intensive Work Preparation and Life Skills Training Inventory     Intensive Work Preparation and Life Skills Training Inventory, VR3387 - PDF version     11/01/2017
VR3388 Intensive Work Preparation and Life Skills Training Individual Program Plan and Monthly Report     Intensive Work Preparation and Life Skills Training Individual Program Plan and Monthly Report, VR3388 - PDF version     11/01/2017
VR3390 Intensive Work Preparation and Life Skills Training Family and Caregiver Support Training Plan Intensive Work Preparation and Life Skills Training Family and Caregiver Support Training Plan, VR3390 - Word version         01/01/2018
VR3391 Intensive Work Preparation and Life Skills Training Staffing Report Intensive Work Preparation and Life Skills Training Staffing Report, VR3391 - Word version         01/01/2018
VR3406 Counseling Progress Report Counseling Progress Report, VR3406 - Word version       Counseling Progress Report, VR3406 - Instruction Sheet 11/01/2017
VR3407 Training Progress Report Training Progress Report, VR3407 - Word version   Training Progress Report, VR3407 - PDF version     11/01/2017
VR3408 Vehicle Modification Evaluation Vehicle Modification Evaluation, VR3408 - Word version         09/03/2019
VR3409 Customer Vehicle Modification Agreement Customer Vehicle Modification Agreement, VR3409 - Word version       Customer Vehicle Modification Agreement, VR3409 - Instruction Sheet 10/01/2017
VR3415 Workers' Compensation Contact Verification Letter Workers' Compensation Contact Verification Letter, VR3415 - Word version       Workers' Compensation Contact Verification Letter, VR3415 - Instruction Sheet 06/03/2019
VR3420 Employment Support for Brain Injury - Referral Employment Support for Brain Injury - Referral, VR3420 - Word version         10/01/2019
VR3422 Reduced Payment Agreement Reduced Payment Agreement, VR3422 - Word version         11/01/2017
VR3433 Mileage Premium Report Mileage Premium Report, VR3433 - Word version         01/02/2019
VR3434 Provider Travel Plan and Report Provider Travel Plan and Report, VR3434 - Word version         03/15/2018
VR3436 Travel Premium Plan and Report Travel Premium Plan and Report, VR3436 - Word version         06/03/2019
VR3441A Entity Headquarters Information Part A - Management Team Entity Headquarters Information Part A - Management Team, VR3441A - Word version         07/01/2019
VR3441B Entity Headquarters Information Part B - Services and Goods Entity Headquarters Information Part B - Services and Goods, VR3441B - Word version         07/01/2019
VR3441C Entity Headquarters Information Part C - Counties Entity Headquarters Information Part C - Counties, VR3441C - Word version         07/01/2019
VR3442A Provider Physical Location Information Part A - Certification Statement Provider Physical Location Information Part A - Certification Statement, VR3442A - Word version         07/01/2019
VR3442B Provider Physical Location Information Part B Provider Physical Location Information Part B, VR3442B - Word version         07/01/2019
VR3443 TWC VR Standards for Providers Certification TWC VR Standards for Providers Certification, VR3443 - Word version         06/28/2018
VR3444 Conflict of Interest Certification Conflict of Interest Certification, VR3444 - Word version         06/28/2018
VR3445 Provider Insurance Verification Provider Insurance Verification, VR3445 - Word version         07/01/2019
VR3448 Employment Supports for Brain Injury - Provider Information and Acknowledgements Employment Supports for Brain Injury - Provider Information and Acknowledgements, VR3448 - Word version         10/01/2019
VR3449 Employment Supports for Brain Injury - Professional Staff Employment Supports for Brain Injury - Professional Staff, VR3449 - Word version         10/01/2019
VR3455 Provider Staff Information Form Provider Staff Information Form, VR3455 - Word version         07/01/2019
VR3472 Contracted Service Modification Request Contracted Service Modification Request, VR3472 - Word version         10/01/2017
VR3490 Temporary Waiver of Credentials Temporary Waiver of Credentials, VR3490 - Word version         10/01/2017
VR3494 Mechanic's Evaluation - Used Vehicle Mechanic's Evaluation - Used Vehicle, VR3494 - Word version         11/01/2017
VR5053 Application Statement for Independent Living Services for Older Individuals Who are Blind (ILS-OIB) Program Application Statement for Independent Living Services for Older Individuals Who are Blind (ILS-OIB) Program, VR5053 - Word version         10/01/2017
VR5053-S Declaración de Solicitud para el Programa de Servicios de Vida Independiente Para Adultos Mayors Ciegos (ILS-OIB) Declaración de Solicitud para el Programa de Servicios de Vida Independiente Para Adultos Mayors Ciegos (I L S - O I B), VR5053-S - Word version         10/01/2017
VR5056 Application for Vocational Rehabilitation Services Application for Vocational Rehabilitation Services, VR5056 - Word version         08/27/2018
VR5056-S Solicitud para Servicios Vocacionales de Rehabilitación Solicitud para Servicios Vocacionales de Rehabilitación, VR5056-S - Word version         08/27/2018
VR5110 Refusal to Participate in TWS-VRS WIOA Section 511 Required Activities Refusal to Participate in TWS-VRS WIOA Section 511 Required Activities, VR5110 - Word version         10/01/2017
VR5110-S Rehusar Participar en Actividades Requeridas de TWS-VRS WIOA Sección 511 Rehusar Participar en Actividades Requeridas de TWS-VRS WIOA Sección 511, VR5110-S - Word version         10/01/2017
VR5111 Guardian Cover Letter Guardian Cover Letter, VR5111 - Word version         10/01/2018
VR5111-S Hoja de presentación del tutor Hoja de presentación del tutor, VR5111-S - Word version         10/01/2018
VR5112 Career Counseling Datasheet Career Counseling Datasheet, VR5112 - Word version         10/01/2017
VR5112-S Hoja de Datos de Asesoría para Carreras Hoja de Datos de Asesoría para Carreras, VR5112-S - Word version         10/01/2017
VR5113 Career Counseling and Information and Referral for Individuals – Subminimum Wage Career Counseling and Information and Referral for Individuals – Subminimum Wage, VR5113 - Word version         10/01/2017
VR5115 TWS-VRS Career Counseling Workbook TWS-VRS Career Counseling Workbook, VR5115 - Word version         10/01/2017
VR5115-S TWC VRS Libro de Trabajo de Asesoría para Carreras TWC VRS Libro de Trabajo de Asesoría para Carreras, VR5115-S - Word version         10/01/2017
VR5118 Section 511 Cover Sheet for Group Three Section 511 Cover Sheet for Group Three, VR5118 - Word version         07/03/2018
VR5118-S Fracción 511 Hoja de Presentación para Grupo Tres Fracción 511 Hoja de Presentación para Grupo Tres, VR5118-S - Word version         07/03/2018
VR5159 Individualized Plan for Employment (IPE) Amendment Individualized Plan for Employment (IPE) Amendment, VR5159 - Word version         07/01/2019
VR5159-S Plan Individualizado de Empleo (IPE) Enmendado Plan Individualizado de Empleo (IPE) Enmendado, VR5159-S - Word version         10/01/2017
VR5163 Individualized Plan for Employment (IPE) Individualized Plan for Employment (I P E), VR5163 - Word version         07/01/2019

Last Verified: October 01, 2019

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