Form Ddd-1405cforff - Quality Assurance Review Transition To Employment Services
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6ARIZONA DEPARTMENT OF ECONOMIC SECURITY
DDD-1405CFORFF (4-17)
Division of Developmental Disabilities ● Employment Support and Services
QUALITY ASSURANCE REVIEW
Transition to Employment Services
QUALIFIED VENDOR NAME:
CONTACT PERSON NAME:
QUALIFIED VENDOR PHONE NUMBER:
QUALIFIED VENDOR MAILING ADDRESS: (No., Street)
CITY
STATE
ZIP CODE
TTE PHYSICAL SITE ADDRESS: (No., Street)
CITY
STATE
ZIP CODE
QUALIFIED VENDOR E-MAIL ADDRESS:
DDD REVIEWER NAME:
DATE OF REVIEW:
REVIEWER PHONE NUMBER:
DIRECT LINE STAFF INTERVIEW
INTERVIEWEE’S NAME (Print)
INTERVIEWEE’S TITLE
DATE OF HIRE / TIME AT PROGRAM
DATE OF INTERVIEW
HOW DO YOU KNOW THE TTE OUTCOMES OF THE MEMBER YOU SERVE?
HOW DO YOU HELP THE MEMBERS REACH THOSE OUTCOMES?
HOW DO YOU MEASURE AND RECORD PROGRESS TOWARD THESE OUTCOMES?
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Parent category: Legal