Form Ddd-1400b - Quality Assurance Review Summary Page 2
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1
2Employment Services
DDD-1400BFORFF (11-17) PAGE 2
QUALITY ASSURANCE REVIEW SUMMARY
Est. Time Frame
Date Completion
Targeted Concerns
Action / Follow-up
Person(s) Responsible
for Completion
Verified
REVIEWER’S SIGNATURE:
REVIEWER’S TITLE:
DATE:
AGENCY REPRESENTATIVE’S SIGNATURE:
REPRESENTATIVE’S TITLE:
DATE:
Routing: Original - Vendor, Copy - Employment Specialist
Equal Opportunity Employer/Program • Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and the Americans with
Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and Title II of the Genetic
Information Nondiscrimination Act (GINA) of 2008; the Department prohibits discrimination in admissions, programs, services, activities,
or employment based on race, color, religion, sex, national origin, age, disability, genetics and retaliation. To request this document
in alternative format or for further information about this policy, contact the Division of Developmental Disabilities ADA Coordinator at
602-542-0419; TTY/TDD Services: 7-1-1. • Free language assistance for DES services is available upon request. Ayuda gratuita con
traducciones relacionadas con los servicios del DES esta disponible a solicitud del cliente.
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