CRS Services Report Forms

Entry Services

  1. Cover Sheet
    Form: VR-118X
  2. Orientation Provider Report
    Form: VR-O
  3. Orientation Attendance Sheet
    Form: VR-OA
  4. ACCES-VR Orientation (Consumer Survey)
    Form: VR-OS
  5. Application Information Sheet
    Form: VR-AIS

Job Placement Services

  1. Coaching Supports for Employment
    Coaching Supports for Employment – Deaf Services
    Work-based Coaching Supports for Employment - Students
    Form: VR-959X, VR-563X and VR-964X
  2. Direct Placement Intake – Tier 1
    Form: VR-921X
  3. Job Seeking and Job Development – Tier 2
    Job Seeking and Job Development – Tier 2 – Deaf Services
    Form: VR-929X and VR-935X
  4. Job Placement – Tier 3
    Job Placement – Tier 3 – Deaf Services
    Form: VR-931X and VR-936X
  5. Job Retention Services – Tier 4
    Job Retention Services – Tier 4 – Deaf Services
    Form: VR-932X and VR937X
  6. Job Placement Monthly Placement Activity Report
    Form: VR-MPAR

Supported Employment Services

  1. Referral to ACCES-VR for Supported Employment
    Form: VR-415
  2. Intake
    Form: VR-571X
  3. Pre-Employment Assessment/Job Development Service (VR-Intensive Service Plan)
    Form: VR-572X
  4. Job Placement Report – Day 5
    Form: VR-573X
  5. Job Placement Report – Day 45
    Form: VR-574X
  6. Job Retention Services Report and Extended Services Job Retention and Career Development Plan
    Form: VR-575X
  7. Hours Per Week Quality Bonus Payment
    Form: VR-576X
  8. Hourly Wage Quality Bonus Report
    Form: VR-577X
  9. Monthly Progress Report for Supported Employment – Formerly VR-417
    Form: VR-MPSE
  10. Extended Services - Monthly Report of Services Provided
    Form: Extended Support Services (Fill in)

Adjunct Services

Benefits Advisement

  1. Benefits Advisement Checklist
    Form: VR-175X

Mobility Services

  1. Travel Competency Form – Mobility Training (VR-MS)
    Time Sheet for Mobility Training (VR-MST)
    Form: VR-MS and VR-MST

Coaching Supports

(For Postsecondary Education, Internship, or Other Activities In Pursuit of Employment Goals)

  1. Coaching Supports (VR-790X)
    Coaching Supports – Deaf Services (VR-791X)
    Form: VR-790X and VR-791X

NYS Claim for Payment Instructions:

  1. Do not bill for Entry Service to Groups and Supported Employment Extended Services on the same Claim for Payment form; they must be billed separately;
  2. Do not include ACCES-VR participant information on the Claim to Payment form;
  3. Send Claim for Payment for Group Orientation Sessions to the ACCES-VR District Office who made the request;
  4. Send Claim for Payment for Supported Employment Extended Services to ACCES-VR Central Office, with a copy of the roster to the ACCES-VR District Office(s).

CRS Performance Review (For ACCES-VR Staff Only)

  1. CRS Performance Review
    Form: VR-REV
  2. Performance Review Protocols (to be posted at a later date)
    Document: Performance Review Protocols
  3. Supported Employment Corrective Action Plan (to be posted at a later date)
    Form: Supported Employment Corrective Action Plan