1. 0 Training: General Training is not public awareness – training has more depth and breadth. If the purpose is to create awareness, the training session is public awareness. Working with individual consumers on devices or troubleshooting problems is “Individual Assistance” under Public Awareness.

2. 1 Training: General Training is provided to individuals (even if they attend as a group) and increases skills/competencies.Training is provided to individuals (even if they attend as a group) and increases skills/competencies. Technical assistance is provided to agencies and involves problem solvingTechnical assistance is provided to agencies and involves problem solving Technical assistance may include training.Technical assistance may include training. If you train as part of TA it can be included here – but if training was the ONLY TA activity, you don’t include it in TA as wellIf you train as part of TA it can be included here – but if training was the ONLY TA activity, you don’t include it in TA as well

3. 2 Training: Geographic Distribution Geographic distribution of those to whom you provided training – not where you provided the training. For consumers, use county of residence. For professionals, use county in which the professional provides services.

4. 3 Insert table on page 40 here.

5. 4 Insert table from page 41 here Training: Training Topics

6. 5 Training: Notes Describe one innovative or high-impact training* activity conducted during this reporting period. Describe one innovative or high-impact training* activity conducted during this reporting period. Describe one transition training conducted during this reporting period. Describe one transition training conducted during this reporting period. Who conducted the training? Who conducted the training? Who attended (including number)? Who attended (including number)? What was the topic, content, and/or approach? What was the topic, content, and/or approach? What was the result? What was the result? Do not include overall descriptions of conferences. Do not include overall descriptions of conferences.

7. 6 Training No performance measures No performance measures No customer satisfaction No customer satisfaction Coordination and Collaboration Coordination and Collaboration Notes Notes

8. 7 Technical Assistance: General TA is provided to agencies, not individuals. Troubleshooting devices for individuals is “Individual Assistance” under Public Awareness. Training focuses on increasing skills and is done for individuals (even in groups) – TA is problem solving for an entity. If training was the only kind of TA you provided, this is training and not TA. If training was only one part of TA, it can be both TA and training.

9. 8 TA: Frequency and Nature 1. How many major technical assistance activities did you conduct during the reporting period? ___ 1. How many major technical assistance activities did you conduct during the reporting period? ___ (Respondents who enter “1” or more will receive balance of section.) (If Item 1=0) You can see a read-only. Complete this section for each major technical assistance activity that you conducted. 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.

10. 9 TA: Frequency and Nature 1. Recipient of technical assistance: 1. Recipient of technical assistance: Radio buttons for “check all that apply”: (1) education agency or organization; (2) employer or business; (3) provider of employment/training services; (4) public or private agency or organization not otherwise classified above; (5) manufacturer/ vendor; (6) other (specify)

11. 10 TA: Frequency and Nature 3. For this technical assistance activity, identify the policy expertise areas and product/service expertise areas that were addressed. If the technical assistance activity included both policy and product/service expertise, select both. 3. For this technical assistance activity, identify the policy expertise areas and product/service expertise areas that were addressed. If the technical assistance activity included both policy and product/service expertise, select both. Note that mandatory transition activities that are technical assistance activities are reported here under product/service expertise. Mandatory transition activities that are training activities are reported in the training section. Radio buttons for “check all that apply”: (1) policy area; (2) product/service area (If policy area) Identify the policy areas on which the technical assistance* focused. Choose all that apply. Radio buttons: (1) ADA/504; (2) IDEA Part C; (3) IDEA Part B; (4) Section 508 and Section 255; (5) WIA/Rehabilitation Act/VR; (6) Medicaid; (7) Medicare; (8) Private insurance; (9) HAVA; (10) Older Americans Act; (11) SSI/SSDI/Work Incentives; (12) Olmstead (13) other (specify) (If product/service area) Identify the product/service areas on which the technical assistance* focused. Choose all that apply. Radio buttons: (1) Web accessibility; (2) accessible IT procurement; (3) AT purchasing (cost-effective options);(4) accessible voting systems; (5) AT eligibility determinations; (6) AT personnel development; (7) AT resource allocation; (8) AT service delivery options; (8) AT legislation/policy development; (9) specific AT device assistance; (10) transition–education; (11) transition–community living; (12) other (specify)

12. 11 TA: Frequency and Nature 4. Duration of technical assistance* during this reporting period: 4. Duration of technical assistance* during this reporting period: Drop-down box: (1) less than 3 months; (2) 3 to 5 months; (3) 6 to 8 months; (4) 9 to 12 months; (5) other (specify) 5. Approximate number of person hours expended by AT program staff to deliver the technical assistance:* (Numeric field) 5. Approximate number of person hours expended by AT program staff to deliver the technical assistance:* (Numeric field) 6. Do you have additional activities to report? 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. 6. Do you have additional activities to report? 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 Items 1 through 5.)

13. 12 TA Coordination and Collaboration Description of TA Activity: - One high-impact or innovative - One high-impact or innovative - One transition - One transition

14. 13 Public Awareness: General Public awareness is intended to reach large audiences and is not as in-depth as training. Public awareness includes: 1. Public Awareness 2. Information Dissemination - Information and Referral (not to be confused with referral related to device demonstration!) - Information and Referral (not to be confused with referral related to device demonstration!) - Individual Assistance

15. 14 Public Awareness Activities Insert table on bottom of 49 top of 50

16. 15 Public Awareness: Individual Assistance Report the number of individuals to whom you provided individual assistance, by primary type of information/assistance provided. Provide a count of the number of individuals assisted, rather than the number of contacts made. If one person made three phone calls in one week, that should be counted as one person assisted, not three. If the three phone calls are for different purposes, select the primary purpose.

17. 16 Public Awareness: Individual Assistance Insert table from top of page 51

18. 17 Public Awareness: I&R Insert table from top of pg 52 here

19. 18 Public Awareness: I&R Each individual assisted with information and/or a referral should be counted only once, regardless of the number of contacts made. Coordination and Collaboration Notes

20. 19 Coordination and Collaboration or State Improvement not Previously Addressed Additional Coordination and Collaboration - same as in other sections - same as in other sections Additional State Improvement Initiatives - same as in other sections - same as in other sections

21. 20 Expenditures and Other Financial Information In this table, report: a. The amount of AT Act funds expended for each state-level activity. a. The amount of AT Act funds expended for each state-level activity. b. The total amount of AT Act funds expended for all state-level activities.* b. The total amount of AT Act funds expended for all state-level activities.* c. The amount of AT Act funds expended for each state leadership activity (not including mandatory transition). c. The amount of AT Act funds expended for each state leadership activity (not including mandatory transition). d. The amount of AT Act funds expended for transition activities. d. The amount of AT Act funds expended for transition activities. e. The total amount of AT Act funds expended for all state leadership activities. e. The total amount of AT Act funds expended for all state leadership activities.

22. 21 Expenditures and Other Financial Information Integrated Programs: Enter MD into the rows for which you cannot individually report expenditures. Then report the total amount of funds used for “integrated activities” in the integrated activities row. Funding only should be reported as integrated when the activities are truly integrated. For example, your device demonstration and device loan programs may share both staff and devices, making it difficult to know how much funds are used for each activity.

23. 22 Expenditures and Other Financial Information Insert table at top of page 59

24. 23 Additional and Leveraged Funds Enter the sources and amounts of non-AT Act funds that you received during this reporting period Enter the sources and amounts of non-AT Act funds that you received during this reporting period Indicate to which activities those funds were allocated. Indicate to which activities those funds were allocated. Report each source and amount in the reporting period that it was received, even if not all of the funds were expended. Report each source and amount in the reporting period that it was received, even if not all of the funds were expended. Do not report AFP endowments or matching funds. Do not report AFP endowments or matching funds. If funds were used for neither State-level or State Leadership activities report in “Other” and complete narrative section. If funds were used for neither State-level or State Leadership activities report in “Other” and complete narrative section.

25. 24 Additional and Leveraged Funds Insert table at top of page 60

26. 25 Additional and Leveraged Funds 2. (If “other” is selected in Item B.1, Row 1) You indicated that funds from (name of funding source) were used for activities other than the state-level and state leadership activities. 2. (If “other” is selected in Item B.1, Row 1) You indicated that funds from (name of funding source) were used for activities other than the state-level and state leadership activities. a. Describe the “other” activities for which these funds were used. a. Describe the “other” activities for which these funds were used. b. How many individuals were served with these additional funds? If you are unable to report this number, enter “MD” for missing data and provide an explanation under “Notes” at the end of this section. (Numeric field) b. How many individuals were served with these additional funds? If you are unable to report this number, enter “MD” for missing data and provide an explanation under “Notes” at the end of this section. (Numeric field) c. What outcomes were accomplished with these additional funds? (Narrative field) c. What outcomes were accomplished with these additional funds? (Narrative field)