ACCES-VR

Adult Career and Continuing Education Services-Vocational Rehabilitation

UCS Services Report Forms

Entry Services

  1. Cover Sheet – 118X or 117X
    Form: VR-118X and VR-117X (Word file, 66KB, 1pg)
  2. Orientation Provider Report
    Form: VR-O (Word file, 62KB, 1pg)
  3. Orientation Attendance Sheet
    Form: VR-OA (Word file, 59KB, 1pg)
  4. ACCES-VR Orientation (Consumer Survey)
    Form: VR-OS (Word file, 59KB, 1pg)
  5. Application Information Sheet
    Form: VR-AIS ( Word file, 56KB, 1pg)

Job Placement Services

  1. Level I
    1. Coaching Supports for Employment – 959X
      Coaching Supports for Employment - Deaf Service – 563X
      Form: VR-959X and VR-563X (Word file, 68KB, 1pg)
  2. Level II
    1. Direct Placement Intake - Tier 1 – 921X
      Form: VR-921X (Word file, 62KB, 1pg)
    2. Job Placement Plan
      Job Seeking and Job Development Services - Tier 2 – 929X
      Job Seeking and Job Development Services (Deaf Service) - Tier 2 – 935X
      Form: VR-929X and VR-935X (Word file, 67KB, 1pg)
    3. Job Placement - Tier 3 - 931X
      Job Placement (Deaf Service) - Tier 3 – 936X
      Form: VR-931X and VR-936X (Word file, 68KB, 1pg)
    4. Job Retention Services - Tier 4 – 932X
      Job Retention Services (Deaf Service) - Tier 4 – 937X
      Form: VR-932X and VR-937X (Word file, 71KB, 2pgs)
    5. Monthly Placement Activity Report
      Job Seeking and Job Development Services - Tier 2 – 929X
      Job Seeking and Job Development Services (Deaf Service) - Tier 2 – 935X
      Job Placement - Tier 3 – 931X
      Job Placement (Deaf Service) - Tier 3 – 936X
      Form: VR-MPAR (Word file, 65KB, 2pgs)

Adjunct Services

  1. Level I
    1. Work & Benefits Community Information Session, Provider Report Form
      Form: VR-BEN 1 (Word file, 62KB, 1pg)
    2. Work & Benefits Community Information Session (Consumer Survey)
      Form: VR-BEN 2 (Word file, 58KB, 1pg)
    3. Work & Benefits Community Information Session, Attendance Sheet
      Form: VR-BEN 3 (Word file, 58KB, 1pg)
  2. Level II
    1. Benefits Advisement Checklist
      Benefits Advisement - Short Term – 175X
      Form: VR-175X (Word file, 84KB, 3pgs)
  3. Level III
    1. Benefits Advisement - Long Term – 176X(I) and 176X(F)
      Form: VR-176X(I) and 176X(F) (Word file, 63KB, 1pg)
  4. Mobility Services
    Travel Competency Form – Mobility Training - MS
    Time Sheet for Mobility Training – MST
    Form: VR-MS and VR-MST ( Word file, 71KB, 2pgs)
  5. Coaching Supports – 790X
    Coaching Supports – Deaf Service – 791X
    (For Postsecondary Education, Internship, or Other Activities In Pursuit of Employment Goals)
    Form: VR-790X and VR-791X (Word file, 63KB, 2pgs)

USC Performance Review (For ACCES-VR Staff Only)

  1. USC Performance Review Forms
    1. UCS Performance Review Cover Page (Page 1)
      Form: VR-REVP1 (Word file, 72KB, 1pg) (For ACCES-VR Staff Only)
    2. UCS Performance Review Continuation Page - use as many sheets as necessary (Page 2)
      Form: VR-REVP2 (Word file, 45KB, 1pg) (For ACCES-VR Staff Only)
    3. UCS Performance Review Summary Page (Page 3)
      Form: VR-REVP3 (Word file, 37KB, 1pg) (For ACCES-VR Staff Only)
    4. Performance Review Protocols (For ACCES-VR Staff Only)
    5. Performance Review Protocols Overview (For ACCES-VR Staff Only)

List of Forms without Description:

  1. Form: VR-118X and VR-117X (Word file, 66KB, 1pg)
  2. Form: VR-O (Word file, 62KB, 1pg)
  3. Form: VR-OA (Word file, 59KB, 1pg)
  4. Form: VR-OS (Word file, 59KB, 1pg)
  5. Form: VR-AIS ( Word file, 56KB, 1pg)
  6. Form: VR-959X and VR-563X (Word file, 68KB, 1pg)
  7. Form: VR-921X (Word file, 62KB, 1pg)
  8. Form: VR-929X and VR-935X (Word file, 67KB, 1pg)
  9. Form: VR-931X and VR-936X (Word file, 68KB, 1pg)
  10. Form: VR-932X and VR-937X (Word file, 71KB, 2pgs)
  11. Form: VR-MPAR (Word file, 65KB, 2pgs)
  12. Form: VR-BEN 1 (Word file, 62KB, 1pg)
  13. Form: VR-BEN 2 (Word file, 58KB, 1pg)
  14. Form: VR-BEN 3 (Word file, 58KB, 1pg)
  15. Form: VR-175X (Word file, 84KB, 3pgs)
  16. Form: VR-176X(I) and 176X(F) (Word file, 63KB, 1pg)
  17. Form: VR-MS and VR-MST ( Word file, 71KB, 2pgs)
  18. Form: VR-790X and VR-791X (Word file, 63KB, 2pgs)
  19. Form: VR-REVP1 (Word file, 72KB, 1pg) (For ACCES-VR Staff Only)
  20. Form: VR-REVP2 (Word file, 45KB, 1pg) (For ACCES-VR Staff Only)
  21. Form: VR-REVP3 (Word file, 37KB, 1pg) (For ACCES-VR Staff Only)

 

Additional Resources

Quick Links to NYS Office of State Comptroller Voucher Forms

  1. AC 92 Standard Voucher (Word Template)Word file Exit site- (AC 92 pdf) PDF file Exit site
  2. NYS Office of State Comptroller AC 92 InstructionsExit site

  3. AC 93 Continuation Sheet (Word Template)Word file Exit site- (AC 93 pdf) PDF file Exit site
  4. NYS Office of State Comptroller AC 93 InstructionsExit site

 

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Last Updated: February 18, 2011