Refer to the DRS Standards for Providers, Chapter 8: Standards for Employment Services, 8.7 Job Skills Training (Job Coaching) and DBS Standards Manual for Consumer Services Contract Providers, Chapter 5: Services, 5.12 Standards for Supported Employment Services and quality criteria for additional details.
The placement must continue to meet all nonnegotiable employment conditions, 50 percent or more of negotiable employment conditions, and at least one targeted job task listed in the SESP—Part 1.
If the consumer is placed in any new subsequent positions or jobs, a new Supported Employment Support Summary (SESP)—Part 2 form must be completed, signed by all parties, and submitted with the DARS1615.
Follow the instructions below when completing this form:
Information on the form must be submitted electronically and be accurate and complete.
The supported employment specialist (SES) will record an answer to all questions. If a question or section does not apply, enter “Not Applicable” or N/A and explain why.
Write narrative summaries in paragraph form in clear, descriptive English.
Indicate how and when you collected the information in the narrative summaries. For example, “the supported employment specialist collected the information through discussion with the consumer’s supervisor on March 5, 2014,” or “the supported employment specialist observed the consumer performing (skill or task) at the job site on March 5, 2014.”
Before submitting with an invoice for payment, review the document to ensure that all questions have been answered, the standards for providers outcomes have been met and that all quality criteria have been met.
Submit invoice for payment no sooner than the day after achievement of the benchmark (for example, the 6th day, the 29thday, the 56th day)
Note: The provider collects the information and completes this form except the section indicated for “DARS Use Only.”
Enter X below to indicate which benchmark this form is being used for.
Job coach and/or job skills trainer verification Not applicable
UNT website verifies that the CRPs staff person listed above is:
NOT Credentialed Credentialed in Job Placement Credentialed in Autism Specialization
If the job coach/job skills trainer is not credentialed, is an approved DARS3490, Temporary Waiver of CRP Credentials, attached to the invoice? (For DRS only. DBS does not use DARS3490.)
If yes, does the DARS3490 approve services with correct service dates?
Printed name of DARS staff member making the verification:
If unable to verify the credentials or the approved DARS3490, complete the following:
The date a copy of the submitted invoice and DARS1615 were returned to the CRP with written notification that CRP staff person did not meet the credential criteria required or submit an approved DARS3490 waiving the required credential. Date:
The date a case note was entered to document the return of invoice and required form(s).
DARS Use Only—Verification of Job Coach and/or Job Skill Trainer
Deaf Services Premium Approval Not applicable
Purchase Order issued for Deaf Service Premium? Yes No. If no, skip to next section. (A copy of the certification should be attached to the form and invoice.)
If Yes, Board for Evaluation of Interpreters (BEI) certification Credentialed Not credentialed
Registry of Interpreters for the Deaf (RID) certification Credentialed Not credentialed
SLPI rating of intermediate plus Credentialed Not credentialed
If unable to verify the credentials, complete the following:
The date a copy of the submitted invoice and DARS 1613 were returned to the CRP with written notification that the CRP staff person did not meet one of the credential criteria required.
The date a case note was entered to document the return of invoice and required form(s)
DARS Use Only—DARS Approval of the DARS1615
Supported Employment Credentials have been verified on the DARS1613.
If the Deaf Employment Premium Services has been authorized, were the supported employment specialist’s or job coach and/or job skills trainer’s credentials for Deaf Employment Premium verified?
Verified that the DARS1615 is accurately completed per form instructions on form and the standards for providers.
Verified that the consumer has been employed at least 28 or 56 days from date of placement.
Verified that the DARS 1615 identifies the consumer’s performance and the consumer’s abilities related to essential job tasks, training needs, and supports to be provided to ensure the consumer’s success.
Verified that extended services and/or long-term supports are being addressed and put into place by the provider.
Verified that consumer, parent and/or guardian, and employer continue to be satisfied with the placement.
Verified that wages are at or above minimum wage but not less than the customary or usual wage paid by the employer for the same or similar work performed by people who do not have disabilities.
Verified that the consumer is working in a “competitive work setting” as defined in the standards for providers.
Verified that the consumer is working in an “integrated work setting” as defined in the standards for providers.
Consumer is satisfied with the job placement via signature on form or by consumer contact.
Verified that all additional requirements of the placement noted in the “special comments” of the service authorization were met.
If any question above is answered “No,” complete the following:
Send a copy of the submitted invoice, DARS1615 and DARS 1613 returned to the CRP with written notification that the placement did not meet the requirements as described in the standards for providers. Date sent:
Record a case note to document the return of invoice and required form(s)
Sent back to provider
Printed name of DARS staff member making verification: