SEP/WAP Work Services Forms

Work Services Home Page For Consumer For Families For Service Providers For Regional Centers Links & Resources

California Department of Developmental Services
1600 9th Street
P. O. Box 944202
Sacramento, CA 94244-2020
Info: (916) 654-1690
TTY: (916) 654-2054

Quick Links

Documents identified by PDF (Portable Document Format) requires the Adobe Acrobat Reader to be viewed and printed. If you do not already have the Adobe Reader, it can be downloaded for free from Adobe.

SEP/WAP Work Services Forms

These forms are to be used by work service (formerly Habilitation) providers and regional centers to process Work Services information. The forms are provided in two formats. The Excel forms can be downloaded and completed using the Microsoft Excel spreadsheet program. The PDF forms can be downloaded and printed using the free Adobe Acrobat Reader. The PDF forms cannot be completed electronically. For further information, please read the instructions accompanying each form.

Program Advisory: Student Eligibility for Habilitation Services for
DS 1964, DS 1971 & DS 1972

DS 1961 SEP - SEP/Individual Habilitation Services Plan
This form is the standardized service plan Supported Employment Program (SEP). Providers use to implement the consumer's vocational goals of the Individual Program Plan (IPP).
Users: SEP service providers.

DS 1961 SEP (7/04) (Excel)
DS 1961 SEP (7/04) (PDF)
Instructions (PDF)

DS 1961 WAP - WAP/Individual Habilitation Services Plan
This form is the standardized service plan Work Activity Program (WAP). Providers use to implement the consumer's vocational goals of the Individual Program Plan (IPP).
Users: WAP service providers.

DS 1961 WAP (7/04) (Excel)
DS 1961 WAP (7/04) (PDF)
Instructions (PDF)

DS 1962 - Request For New SEP Groups
A Supported Employment Program-Group Placement (SEP-GP) approval request is submitted by service providers to DDS to obtain approval of new SEP groups.
Users: SEP-GP service providers.

DS 1962 (1/2005) (Excel)
DS 1962 (1/2005) (PDF)
Instructions (PDF)

DS 1963 - Request For Approval Of SEP Group Changes
This form is submitted by service providers to request changes in a specific approved supported employment program group.
Users: SEP-GP service providers.

DS 1963 (1/2005) (Excel)
DS 1963 (1/2005) (PDF)
Instructions (PDF)

DS 1964 - Supported Employment Group Billing and Attendance Form
This form must be completed as an excel file, password protected and submitted to regional centers, DOR and DDS monthly. After downloading the file, enter the vendor information at the top of the form and consumer and job coach information up to the "Funded By" column. Save a copy of this file as a "master". Should any problem arise with the form, the "master" is available to start over.

DS 1964 (11/2008) (Excel) Updated DS 1964
Macro Instructions (PDF)

DS 1968 - Vocational Rehabilitation Referral
This form is used to refer consumers to the Department of Rehabilitation for Vocational Rehabilitation Services.
Users: Regional Center Service Coordinators.

DS 1968 (4/04) (Excel)
DS 1968 (4/04) (PDF)
Instructions (PDF)

DS 1969 - Vocational Services Exit Report
This form is completed when a consumer exits a habilitation services program.
Users: Regional Center Service Coordinators and Habilitation Services Providers.

DS 1969 (4/04) (Excel)
DS 1969 (4/04) (PDF)
Instructions (PDF)

DS 1970 SEP-IP - SEP-IP/Habilitation Services Vendor Profile
This form is used to briefly describe the services, staff and philosophy of the Supported Employment Program-Individual Placement (SEP-IP) service provider's program.
Users: SEP-IP Services Providers.

DS 1970 SEP IP (4/04) (Excel)
DS 1970 SEP IP (4/04) (PDF)
Instructions (PDF)

DS 1970 SEP-GP - SEP-GP/Habilitation Services Vendor Profile
This form is used to briefly describe the services, staff and philosophy of the Supported Employment Program-Individual Placement (SEP-GP) service provider's program.
Users: SEP-IP Services Providers.

DS 1970 SEP GP (4/04) (Excel)
DS 1970 SEP GP (4/04) (PDF)
Instructions (PDF)

DS 1970 WAP - WAP/Habilitation Services Vendor Profile
This form is used to briefly describe the services, staff and philosophy of the Work Activity Program- service provider's program.
Users: WAP Services Providers.

DS 1970 WAP (4/04) (Excel)
DS 1970 WAP (4/04) (PDF)
Instructions (PDF)

DS 1971 WAP - WAP/Work Activity Program Consumer Monthly Report

Outcome data for consumers provided Work Activity Program services is documented on this form.
Users: WAP Services Providers; Regional Center can preload consumer names and identification numbers.

DS 1971 WAP (7/2006) (Excel)
DS 1971 WAP (7/2006) (PDF)
Instructions (PDF)

DS 1972 SEP IP - SEP/Supported Employment Individual Placement Consumer Monthly Report
Outcome data for consumers provided Supported Employment Program- Individual Placement services is documented on this form.
Users: SEP Services Providers; Regional Center can preload consumer names and identification numbers.

DS 1972 SEP IP (7/2006) (Excel)
DS 1972 SEP IP (7/2006) (PDF)
Instructions (PDF)

If you have any questions regarding these forms, please send an e-mail to
work.services@dds.ca.gov.