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DDS Logo California Department of Developmental Services
1600 9th Street
P. O. Box 944202
Sacramento, CA 94244-2020

Info: (916) 654-1690
TTY: (916) 654-2054

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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 Excel forms can be downloaded and completed using the Microsoft Excel spreadsheet program. The PDF instructions can be downloaded and printed using the free Adobe Acrobat Reader. For further information, please read the instructions accompanying each form.

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

Supported Employment Program -- Individual Forms

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 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.

Supported Employment Program -- Group Forms

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 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 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.

Work Activity Program Forms

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 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.

Vocational Rehabilitation Forms

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 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.

 
Last Updated: 6/24/2015