1. 0 State Financing: General A state financing activity is approved as part of your State Plan for AT. Examples include: financial loan programs financial loan programs “last resort” activities with non-AT Act dollars “last resort” activities with non-AT Act dollars specialized case management specialized case management cooperative buying cooperative buying telecommunications distribution with non-AT Act dollars telecommunications distribution with non-AT Act dollars activities that finance home modifications with non-AT Act dollars activities that finance home modifications with non-AT Act dollars

2. 1 State Financing: General 1. Did your statewide AT program conduct any state financing activities* during the reporting period? Drop-down box: (1) yes; (2) no, statewide AT program exercised state flexibility; (3) no, statewide AT program claimed comparability; (4) no, statewide AT program is developing an activity not yet implemented (include feasibility studies here) (Respondents who choose “1” will receive balance of section. Those who choose 2-4 will have the option to view only.)

3. 2 State Financing: Financial Loan Programs Did the statewide AT program conduct a financial loan program during the reporting period? Drop-down box: (1) yes; (2) no A financial loan program is a program that provides loans for purchase of AT devices and services. A financial loan program is a program that provides loans for purchase of AT devices and services. Do not report Access to Telework funds here! Do not report Access to Telework funds here!

4. 3 State Financing: Financial Loan Programs Two kinds of loan programs are considered:  Revolving loans made directly by the Statewide AT Program  Partnership loans using dollars from another source  This does not include loans in which you had no financial or administrative role.

5. 4 State Financing: Financial Loan Programs, Loan Applications This is not applications simply accepted. This is applications actually reviewed to the extent that a decision was made about them. Report an application in the reporting period in which a decision was made, not the reporting period in which it was received. Decisions on applications fall into three categories:  Approved – loan made  Approved – loan not made (you approved the loan, but the consumer declined for some reason)  Rejected

6. 5 State Financing: Number and Geographic Distribution of Loans Number of Applications Area of Residence Total Metro RUCC 1-3 Urban RUCC 4-7 Rural RUCC 8-9 A. Approved—loan made System- generated B. Approved—loan not made* (i.e., the application was withdrawn after the loan was approved, or the loan was approved but not accepted by the consumer) System- generated C. Rejected System- generated D. Total System- generated

7. 6 State Financing: Financial Loan Programs, Applicant Income This applies only to those to whom a loan was made. This applies only to those to whom a loan was made. The income is the gross annual income reported on the loan applications (i.e., the amount upon which the decision about the loan was based). The income is the gross annual income reported on the loan applications (i.e., the amount upon which the decision about the loan was based). a. Enter the lowest and highest income reported among all applicants to whom loans were made during the reporting period: Lowest:$______________ Highest:$______________

8. 7 State Financing: Income of Applicants A Sum of Incomes B Number of Applicants to Whom Loans Were made C Average Gross Annual Income $System- generated

9. 8 State Financing: Range of Income Number and Percentage of Loans Made to Applicants with Incomes of Total $15,000 or Less $15,0001 to $20,000 $20,001 to $25,000 $25,001 to $30,000 $30,001 to $35,000 $35,001 or More Number of Loans System- generated Percentage of Loans System- generated

10. 9 State Financing: Financial Loan Programs, Types and Dollar Amounts of AT Financed A loan may pay for more than 1 device, so the number of devices and services may not be equal. A loan may pay for more than 1 device, so the number of devices and services may not be equal. Group large building access projects (e.g., a bathroom modification or exterior ramping of a house would each be one home modification). Group large building access projects (e.g., a bathroom modification or exterior ramping of a house would each be one home modification). Include services funded in the AT category associated with the service (e.g., an audiological evaluation would go in the “hearing” category). Include services funded in the AT category associated with the service (e.g., an audiological evaluation would go in the “hearing” category).

11. 10 State Financing: Type of Loan Type of Loan Number of Loans Percentage of Loans Revolving LoanSystem- generated Loan guarantee* (no special interest rate)System- generated Low interest (prime or less)* Without interest buy-down* onlySystem- generated With interest buy-down* onlySystem- generated With loan guarantee* onlySystem- generated With both interest buy-down* and loan guarantee*System- generated Preferred interest (greater than prime*) Without interest buy-down* onlySystem- generated With interest buy-down* onlySystem- generated With loan guarantee* onlySystem- generated With both interest buy-down* and loan guarantee*System- generated Other (specify)System- generated TotalSystem- generated

12. 11 State Financing: Dollar Value of Loans Type of LoanNumber of LoansDollar Value of Loans Revolving loans*System- generated$ Partnership loans*System- generated$ TotalSystem- generated

13. 12 State Financing: Financial Loan Programs, Interest Rates 1. Interest Rates a. Enter the lowest and highest interest rates among all loans made, including both revolving and partnership loans. For interest buy-downs, report the interest rate to which you bought the loan down: a. Enter the lowest and highest interest rates among all loans made, including both revolving and partnership loans. For interest buy-downs, report the interest rate to which you bought the loan down: Lowest:______________% Highest:______________%

14. 13 State Financing: Average Interest Rate A Sum of Interest Rates B Number of Loans Made C Average Interest Rate System- generated

15. 14 State Financing: Range of Interest Rates Number of Loans Made at Interest Rates of Total Number of Loans 0-2.0%2.1-4.0%4.1-6.0%6.1-8.0%8.1-10%10.1-12%12.0-14%14+% System- generated

16. 15 State Financing: Types of Devices Financed Type of AT Device/Service Number Financed Dollar Value of Loans Speech communication Vision Hearing Computers and related Daily living Learning, cognition, and developmental Environmental adaptations Mobility, seating and positioning Vehicle modification and transportation Recreation, sports, and leisure Other (specify) TotalSystem- generated

17. 16 State Financing: Financial Loan Programs, Default a. In this section, use the definition(s) of default established for your financial loan program. Please indicate how your program determines when a loan is in default: (Narrative field)

18. 17 State Financing: Percentage of Defaulted Loans Number of Loans in Default Number of Outstanding Loans Percentage of Loans in Default System- generated

19. 18 State Financing: Net Dollar Loss Net Dollar Loss on Loans Total Dollar Value of Outstanding Loans Default Rate* System- generated

20. 19 State Financing: Other State Financing Activities Activities that provide consumers with resources and services that result in the acquisition of AT devices and services. These activities provide new funding or devices (directly or indirectly), not cost savings. “last resort” activities with non-AT Act dollars “last resort” activities with non-AT Act dollars specialized case management specialized case management telecommunications distribution telecommunications distribution activities that finance home modifications with non-AT Act dollars activities that finance home modifications with non-AT Act dollars Telework Telework

21. 20 State Financing: Other State Financing Activities 1. General Information a. Did the statewide AT program conduct another state financing activity? Drop-down box: (1) yes; (2) no (Respondents who choose “1” will receive balance of section.) (If “Yes” to Item 1) Complete this section for that activity. If you have more than one activity to report, you will need to complete this section more than once. After you have completed your first entry, you will be given an opportunity to repeat this section in order to report additional activities. b. Which of the following describes this state financing activity? Drop-down box: (1) Access to Telework Funds; (2) “last resort”activity; (3) specialized case management; (4) financing for home modifications; (5) telecommunications distribution; (6) other (specify)

22. 21 “Other” State Financing: Geographic Distribution County of ResidenceNumber of Individuals Metro (RCCU 1-3) Metro (RCCU 4-7) Metro (RCCU 8-9) TotalSystem- generated

23. 22 State Financing: Other State Financing Activities Types and Dollar and Dollar Amounts - same as financial loans, except: “number funded” vs. “number financed” “number funded” vs. “number financed” “value of AT provided” vs. “dollar value of loan” “value of AT provided” vs. “dollar value of loan” Value of AT Provided: This is not how much funding you secured – it is value of device obtained. This is not how much funding you secured – it is value of device obtained. Use the MSRP. If you can’t find the exact price for a particular item, use the value of a comparable device. Use the MSRP. If you can’t find the exact price for a particular item, use the value of a comparable device.

24. 23 “Other” State Financing: Types of Devices Funded Type of AT Device/Service Number Funded Value of AT Provided Speech communication$ Vision$ Hearing$ Computers and related$ Daily living$ Learning, cognition, and developmental$ Environmental adaptations$ Mobility, seating and positioning$ Vehicle modification and transportation$ Recreation, sports, and leisure$ Other (specify)$ TotalSystem- generated$ System- generated

25. 24 State Financing: Other State Financing Activities 4. Additional Activities Do you have additional activities to report in this section? If so, select “yes” and the system will repeat this section. If you select “no,” it will take you to the next section of the reporting form. Drop-down box: (1) yes; (2) no (Respondents who choose “1” will repeat this section.)

26. 25 State Financing Activities That Allow Consumers to Obtain AT at Reduced Cost Examples: Cooperative buying Cooperative buying Others? Others? General Information – same as “Other State Financing Activities” Geographic Distribution – same as “Other State Financing Activities”

27. 26 State Financing Activities That Allow Consumers to Obtain AT at Reduced Cost Savings to Consumers, by Type of AT Device/Service – same as “Other State Financing Activities” except: Savings to Consumers, by Type of AT Device/Service – same as “Other State Financing Activities” except: You must know the estimated purchase price (price before savings) and the “actual” price (price at which it sold) to calculate cost savings. You must know the estimated purchase price (price before savings) and the “actual” price (price at which it sold) to calculate cost savings. Use the MSRP to determine the current purchase price of the device. If you can’t find the exact price, use the value of a comparable device. Use the MSRP to determine the current purchase price of the device. If you can’t find the exact price, use the value of a comparable device.

28. 27 State Financing Activities That Allow Consumers to Obtain AT at Reduced Cost Type of AT Device/Service Number Funded Total Estimated Current Purchase Price Total Amount for Which Devices Were Sold Savings to Consumers Speech communication System- generated VisionSystem- generated HearingSystem- generated Computers and relatedSystem- generated Daily livingSystem- generated Learning, cognition, and developmental System- generated Environmental adaptationsSystem- generated Mobility, seating and positioningSystem- generated Vehicle modification and transportationSystem- generated Recreation, sports, and leisureSystem- generated Other (specify)System- generated Total System- generated

29. 28 State Financing Activities That Allow Consumers to Obtain AT at Reduced Cost Additional Activities Do you have additional activities to report in this section? If so, select “yes” and the system will repeat this section. If you select “no,” it will take you to the next section of the reporting form. Do you have additional activities to report in this section? If so, select “yes” and the system will repeat this section. If you select “no,” it will take you to the next section of the reporting form. Drop-down box: (1) yes; (2) no Drop-down box: (1) yes; (2) no (Respondents who choose “1” will repeat this section.) (Respondents who choose “1” will repeat this section.)Anecdote