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It serves as a final report submitted for payment, detailing the assistance provided to individuals seeking VR services. The form includes sections for authorization number, participant ID, VR district office information, vendor details, and customer contact information. A crucial part of the form lists the application assistance provided, such as VR-04, VR-21, VR-22, VR-26, and other supporting documents as well as disability documentation submitted. Specific checkboxes allow for the indication of various submitted documents, including social security disability benefits documentation, physician's reports, worker's compensation authorizations, and medical/psychological reports with specified types and dates. The 'Observations' section prompts for detailed information regarding the individual's physical or mental impairment, functional limitations, impediments to employment, treatment history, education, and work history. The form also includes fields for the completed name, title, phone, and email of the person submitting the report. A section for ACCES-VR use only notes the date the provider was notified if the packet is incomplete. This report is essential for tracking and processing payments for entry-level support services provided to individuals by 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is the purpose of the VR-118X form?","Question",{"text":108,"@type":109},"The VR-118X form is a final report submitted for payment, detailing entry services provided to individuals seeking Vocational Rehabilitation (VR) support.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What types of application assistance and disability documentation can be indicated on this form?",{"text":113,"@type":109},"The form allows for indicating assistance provided concerning VR services applications (like VR-04, VR-21, VR-22, VR-26) and various disability documentation, including Social Security Disability benefits, physician reports, and worker's compensation authorizations.",{"name":115,"@type":106,"acceptedAnswer":116},"What information is required in the 'Observations' section?",{"text":117,"@type":109},"The 'Observations' section requires detailed information about the individual's physical or mental impairment, functional limitations, impediments to employment, treatment history, 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--- | --- |\n| Aware Participant ID |  |\n\n\n| VR District Office: | Vendor: |\n| --- | --- |\n| VRC Name: | SFS Vendor ID: |\n|  | Report Date: |\n\n\n| Customer First Name: | Customer Last Name: |\n| --- | --- |\n| Customer Phone Number: |  |\n| Customer Email Address: |  |\n\n\n| Entry Service Details\u003Cbr>Note: Unit of service is submission of a completed application and eligibility determination information\u003Cbr>This is a Final Report Submitted for Payment |\n| --- |\n| Please indicate the application assistance provided and disability documentation submitted below:\u003Cbr>☐ Application for VR Services (VR-04)\u003Cbr>☐ Information Release Authorization (VR-21) (3 Copies)\u003Cbr>☐ Information Release Authorization (VR-22) (3 Copies)\u003Cbr>☐ Confidential Health Assessment (VR-26)☐ Application Information Sheet\u003Cbr>☐ Voter Registration\u003Cbr>☐ Other Information: |\n\n\n| Disability Information Submitted: |  |\n| --- | --- |\n| ☐ Documentation of Social Security Disability, SSI and/or Public Assistance benefits ☐ Physician Cover Letter with Release to Work / Estimated Physical Capacities Form ☐ Workers Compensation Authorization to Disclose (OC-110A)\u003Cbr>☐ Medical/Psychological Report\u003Cbr>Please Specify the Type and Date of Report |  |\n| Report Type | Date |\n|  |  |\n| Observations:\u003Cbr>(Please provide detailed information regarding the individual’s physical or mental impairment, functional limitations, impediments to employment, treatment history (as applicable), education and work history.) |  |\n\nCompleted By:  \nPrinted Name Title  \nPhone: Email:  \nFor ACCES-VR use Only:  \nIf packet is incomplete, please note the date the provider was notified:","cbCaicFoJe3WM7Ai","https://ap.wps.com/l/cbCaicFoJe3WM7Ai","pdf",255117,"English","# VR-118X Entry Services\n## Entry Service II -Service to Individuals\n## Authorization #\n## Aware Participant ID\n## VR District Office\n## Vendor\n## Customer Contact Information\n## Entry Service Details\n## Disability Information Submitted","[{\"question\":\"What is the purpose of the VR-118X form?\",\"answer\":\"The VR-118X form is a final report submitted for payment, detailing entry services provided to individuals seeking Vocational Rehabilitation (VR) support.\"},{\"question\":\"What types of application assistance and disability documentation can be indicated on this form?\",\"answer\":\"The form allows for indicating assistance provided concerning VR services applications (like VR-04, VR-21, VR-22, VR-26) and various disability documentation, including Social Security Disability benefits, physician reports, and worker's compensation authorizations.\"},{\"question\":\"What information is required in the 'Observations' section?\",\"answer\":\"The 'Observations' section requires detailed information about the individual's physical or mental impairment, functional limitations, impediments to employment, treatment history, education, and work history.\"}]","VR-118X Entry Services - Entry Service II - Service to Individuals | PDF"]