Form Ddd-1402a Forff - Group Supported Employment Services Quarterly Report Page 2
Download a blank fillable Form Ddd-1402a Forff - Group Supported Employment Services Quarterly Report in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Ddd-1402a Forff - Group Supported Employment Services Quarterly Report with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2ARIZONA DEPARTMENT OF ECONOMIC SECURITY
DDD-1402A FORFF (6-17) Page 2
Division of Developmental Disabilities (DDD)
Group Supported Employment Services - QUARTERLY REPORT
Progress Made on Above Outcome(s):
Barrier Keeping individual form Making a Progressive Move to Community Integrated Employment
(i.e. Member choice, family choice, challenging behavior, health issues, no transportation, limited job availability, other.)
Plan of Action to Address Barrier Listed Above:
(i.e. Member education, family education, DB101, Behavior Treatment Planning, employer outreach, healthcare changes, other).
QUALIFIED VENDOR ADMINISTRATOR/DESIGNEE’S NAME (Print)
QUALIFIED VENDOR ADMINISTRATOR/DESIGNEE’S TITLE
QUALIFIED VENDOR ADMINISTRATOR/DESIGNEE’S SIGNATURE
DATE
Routing: Original – Support Coordinator
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. Disponible en español en línea o en la oficina local.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal