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.
Users: SEP service providers.
- DS 1961 SEP (6/2016) EXCEL
- Instructions (6/2016) 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 (10/2019) EXCEL
- Instructions PDF
Users: SEP-GP service providers.
- DS 1962 (1/2005) EXCEL
- Instructions (8/2012) PDF
- DS 1962/Supplemental Narrative Summary Guidance Template (4/2020) EXCEL
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 (6/2016) EXCEL
- Instructions (6/2016) 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 Large (1-900 lines – April 2022) – 64Bit compatible Excel
- DS 1964 Large (1-900 lines – Rate $39.57) – 64Bit compatible Excel
- Macro Instructions PDF
- DS 1961 WAP (6/2016) EXCEL
- Instructions (6/2016) 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
- Instructions PDF
Users: Regional Center Service Coordinators.
- DS 1968 (4/2004) EXCEL
- 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 (4/2004) EXCEL
- Instructions PDF
Last modified: June 22, 2022