Employment Support Services Contract and Forms

ESS-C-353-1 — ESS Assessment - Cognitive Assessment

Form Number: 

ESS-C-353-1

ESS-C-349 — ESS Assessment Referral
ESS-C-353-1 — ESS Assessment - Cognitive Assessment
ESS-C-353-2 — ESS Assessment - Communication Assessment
ESS-C-353-3 — ESS Assessment - Computer Technology Assessment
ESS-C-353-4 — ESS Assessment - Daily Living Assessment
ESS-C-353-5 — ESS Assessment - Housing Assessment
ESS-C-353-6 — ESS Assessment - Mobility Assessment
ESS-C-353-7 — ESS Assessment - Work/Training Tolerance Assessment
ESS-C-353-8 — ESS Assessment - Transportation Assessment
ESS-C-353-9 — ESS Assessment Summary

File Origination or Revision Date: 

02/20/2020

Tags: 

ESS-C-353-2 — ESS Assessment - Communication Assessment

Form Number: 

ESS-C-353-2

ESS-C-349 — ESS Assessment Referral
ESS-C-353-1 — ESS Assessment - Cognitive Assessment
ESS-C-353-2 — ESS Assessment - Communication Assessment
ESS-C-353-3 — ESS Assessment - Computer Technology Assessment
ESS-C-353-4 — ESS Assessment - Daily Living Assessment
ESS-C-353-5 — ESS Assessment - Housing Assessment
ESS-C-353-6 — ESS Assessment - Mobility Assessment
ESS-C-353-7 — ESS Assessment - Work/Training Tolerance Assessment
ESS-C-353-8 — ESS Assessment - Transportation Assessment
ESS-C-353-9 — ESS Assessment Summary

File Origination or Revision Date: 

02/20/2020

Tags: 

ESS-C-353-3 — ESS Assessment - Computer Technology Assessment

Form Number: 

ESS-C-353-3

ESS-C-349 — ESS Assessment Referral
ESS-C-353-1 — ESS Assessment - Cognitive Assessment
ESS-C-353-2 — ESS Assessment - Communication Assessment
ESS-C-353-3 — ESS Assessment - Computer Technology Assessment
ESS-C-353-4 — ESS Assessment - Daily Living Assessment
ESS-C-353-5 — ESS Assessment - Housing Assessment
ESS-C-353-6 — ESS Assessment - Mobility Assessment
ESS-C-353-7 — ESS Assessment - Work/Training Tolerance Assessment
ESS-C-353-8 — ESS Assessment - Transportation Assessment
ESS-C-353-9 — ESS Assessment Summary

File Origination or Revision Date: 

02/20/2020

Tags: 

ESS-C-353-4 — ESS Assessment - Daily Living Assessment

Form Number: 

ESS-C-353-4

ESS-C-349 — ESS Assessment Referral
ESS-C-353-1 — ESS Assessment - Cognitive Assessment
ESS-C-353-2 — ESS Assessment - Communication Assessment
ESS-C-353-3 — ESS Assessment - Computer Technology Assessment
ESS-C-353-4 — ESS Assessment - Daily Living Assessment
ESS-C-353-5 — ESS Assessment - Housing Assessment
ESS-C-353-6 — ESS Assessment - Mobility Assessment
ESS-C-353-7 — ESS Assessment - Work/Training Tolerance Assessment
ESS-C-353-8 — ESS Assessment - Transportation Assessment
ESS-C-353-9 — ESS Assessment Summary

File Origination or Revision Date: 

02/20/2020

Tags: 

ESS-C-353-5 — ESS Assessment - Housing Assessment

Form Number: 

ESS-C-353-5

ESS-C-349 — ESS Assessment Referral
ESS-C-353-1 — ESS Assessment - Cognitive Assessment
ESS-C-353-2 — ESS Assessment - Communication Assessment
ESS-C-353-3 — ESS Assessment - Computer Technology Assessment
ESS-C-353-4 — ESS Assessment - Daily Living Assessment
ESS-C-353-5 — ESS Assessment - Housing Assessment
ESS-C-353-6 — ESS Assessment - Mobility Assessment
ESS-C-353-7 — ESS Assessment - Work/Training Tolerance Assessment
ESS-C-353-8 — ESS Assessment - Transportation Assessment
ESS-C-353-9 — ESS Assessment Summary

File Origination or Revision Date: 

02/20/2020

Tags: 

ESS-C-353-6 — ESS Assessment - Mobility Assessment

Form Number: 

ESS-C-353-6

ESS-C-349 — ESS Assessment Referral
ESS-C-353-1 — ESS Assessment - Cognitive Assessment
ESS-C-353-2 — ESS Assessment - Communication Assessment
ESS-C-353-3 — ESS Assessment - Computer Technology Assessment
ESS-C-353-4 — ESS Assessment - Daily Living Assessment
ESS-C-353-5 — ESS Assessment - Housing Assessment
ESS-C-353-6 — ESS Assessment - Mobility Assessment
ESS-C-353-7 — ESS Assessment - Work/Training Tolerance Assessment
ESS-C-353-8 — ESS Assessment - Transportation Assessment
ESS-C-353-9 — ESS Assessment Summary

File Origination or Revision Date: 

02/20/2020

Tags: 

ESS-C-353-7 — ESS Assessment - Work/Training Tolerance Assessment

Form Number: 

ESS-C-353-7

ESS-C-349 — ESS Assessment Referral ESS-C-353-1 — ESS Assessment - Cognitive Assessment
ESS-C-353-2 — ESS Assessment - Communication Assessment ESS-C-353-3 — ESS Assessment - Computer Technology Assessment
ESS-C-353-4 — ESS Assessment - Daily Living Assessment ESS-C-353-5 — ESS Assessment - Housing Assessment
ESS-C-353-6 — ESS Assessment - Mobility Assessment
ESS-C-353-7 — ESS Assessment - Work/Training Tolerance Assessment
ESS-C-353-8 — ESS Assessment - Transportation Assessment
ESS-C-353-9 — ESS Assessment Summary

File Origination or Revision Date: 

02/20/2020

Tags: 

ESS-C-353-8 — ESS Assessment - Transportation Assessment

Form Number: 

ESS-C-353-8

ESS-C-349 — ESS Assessment Referral ESS-C-353-1 — ESS Assessment - Cognitive Assessment
ESS-C-353-2 — ESS Assessment - Communication Assessment ESS-C-353-3 — ESS Assessment - Computer Technology Assessment
ESS-C-353-4 — ESS Assessment - Daily Living Assessment ESS-C-353-5 — ESS Assessment - Housing Assessment
ESS-C-353-6 — ESS Assessment - Mobility Assessment
ESS-C-353-7 — ESS Assessment - Work/Training Tolerance Assessment
ESS-C-353-8 — ESS Assessment - Transportation Assessment
ESS-C-353-9 — ESS Assessment Summary

File Origination or Revision Date: 

02/20/2020

Tags: 

ESS-C-353-9 — ESS Assessment Summary

Form Number: 

ESS-C-353-9

ESS-C-349 — ESS Assessment Referral ESS-C-353-1 — ESS Assessment - Cognitive Assessment
ESS-C-353-2 — ESS Assessment - Communication Assessment ESS-C-353-3 — ESS Assessment - Computer Technology Assessment
ESS-C-353-4 — ESS Assessment - Daily Living Assessment ESS-C-353-5 — ESS Assessment - Housing Assessment
ESS-C-353-6 — ESS Assessment - Mobility Assessment
ESS-C-353-7 — ESS Assessment - Work/Training Tolerance Assessment
ESS-C-353-8 — ESS Assessment - Transportation Assessment
ESS-C-353-9 — ESS Assessment Summary

File Origination or Revision Date: 

02/20/2020

Tags: 

ESS-C-358n — Copy of e-mail to DRS Counselor of ESS Training Support Plan

Form Number: 

ESS-C-358n

Instructions for ESS-C-358-N — (Copy of e-mail to DRS Counselor of ESS Training Support Plan retained in case file.)

(In contract: ESSC)

Copy of e-mail to DRS Counselor must be emailed to the DRS Counselor and maintained in the individual’s Case Documentation file.

File Origination or Revision Date: 

02/25/2020

Tags: 

ESS-C-361n — DRS Counselor Approval ESS Training Support Plan

Form Number: 

ESS-C-361n

Instructions for ESS-C-361n (DRS Counselor Approval ESS Training Support Plan)

(In contract: ESSC)

The Contractor and the individual identify the work and community skills to be provided on the ESS Training Support Plan. The Contractor will email the ESS Training Support Plan to the DRS Counselor for approval prior to initiating services.

Training Support Plan must be emailed to DRS Counselor for required documentation for payment and a copy of the Training Support Plan email sent to the DRS Counselor. DRS Counselor’s Approval of ESS Training Support Plan (email) (All of these must be maintained in individual’s Case Documentation file.)

File Origination or Revision Date: 

02/25/2020

Tags: