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{"sheet":"Instructions","index":0,"n_rows":68,"n_cols":11,"rows_kept":68,"cut":false,"hidden":false,"merged":[[67,8,67,9],[61,3,61,7],[62,0,62,7],[63,3,63,7],[64,0,64,10],[65,0,67,0],[65,5,65,6],[65,8,65,9],[66,5,66,6],[66,8,66,9],[67,5,67,6],[60,3,60,7],[49,3,49,7],[50,3,50,7],[51,3,51,7],[52,3,52,7],[53,3,53,7],[54,3,54,7],[55,3,55,7],[56,3,56,7],[57,3,57,7],[58,3,58,7],[59,3,59,7],[48,3,48,7],[35,1,35,10],[36,1,36,10],[37,1,37,10],[38,1,38,10],[39,0,39,7],[39,8,63,10],[40,0,61,0],[40,3,40,7],[41,3,41,7],[42,3,42,7],[43,3,43,7],[44,3,44,7],[45,3,45,7],[46,3,46,7],[47,3,47,7],[21,0,21,10],[26,1,26,10],[27,1,27,10],[28,0,28,10],[29,0,38,0],[29,1,29,10],[30,1,30,10],[31,1,31,10],[32,1,32,10],[33,1,33,10],[34,1,34,10],[22,0,27,0],[22,1,22,10],[23,1,23,10],[24,1,24,10],[25,1,25,10],[8,0,8,10],[9,0,9,10],[10,1,10,10],[11,0,11,10],[12,0,20,0],[12,1,12,10],[13,1,13,10],[14,1,14,10],[15,1,15,10],[16,1,16,10],[17,1,17,10],[18,1,18,10],[19,1,19,10],[20,1,20,10],[0,0,0,10],[1,0,7,0],[1,1,1,10],[2,1,2,10],[3,1,3,10],[4,1,4,10],[5,1,5,10],[6,1,6,10],[7,1,7,10]]}
["GENERAL INFORMATION:"]
[null,"This Excel file consists of 1 worksheet.  The worksheet is labeled as to its function. "]
[null,"If you are unable to see the tab for the worksheet across the bottom of the screen, click on the maximize button (the center button) located in the upper right hand corner of the worksheet. "]
[null,"The  worksheet is protected to prevent the changing of formulas and formatting features built into the spreadsheets. "]
[null,"You may submit completed forms in an electronic format or printed format.  You must ensure that consumer information is protected as required by State and Federal law. "]
[null,"FOR ELECTRONIC FORMATS ONLY: If you submit this form to the regional center as an email attachment or on a CD ROM use the following naming standard:  Each file must start with the designation of \"L\" followed by the provider's three digit numerical designation and the month and year. See chart for month designations.  For example: L372-JA04 is Form DS 1972 SEP IP for provider ID# 372 for January 2004."]
[null,"You are required to email the completed form to the following agencies:\nRegional Center: Email this form to each regional center being billed.\nDepartment of Developmental Services (DDS): Work.Services@dds.ca.gov\nForms must be submitted no later than the 15th day of the following month of service. "]
[null,"FOR ELECTRONIC FORMATS ONLY: This form contains information protected under the Health Insurance Portability and Accountability Act (45 C.F.R  Parts 160, 162 and 164).  The file must be password protected to ensure the safety of the consumer's information.  Coordinate with the regional center regarding protecting the consumer information contained in this form."]
["PROVIDER INSTRUCTIONS:"]
["NOTICE"]
[null,"Read the notice and use the information to safeguard the consumer's information in accordance with the Health Insurance Portability and Accountability Act (45 C.F.R  Parts 160, 162 and 164).  "]
["Program Information"]
[null,"Program Name: Enter the name of the program as vendored by the regional center."]
[null,"Program Address: Enter the address/City/State/ZIP where the supported employment program is administered from. (May be different from business/administrative address.)"]
[null,"Vendoring Regional Center: Enter the Abbreviation for the regional center (see attached list) which authorized services for the consumer, If Department of Rehabilitation is funding vocational rehabilitation services enter DOR."]
[null,"User Regional Center: (list all) Enter the abbreviation for the regional center (see attached list) which is utilizing services for the consumer."]
[null,"Completed By:  Enter the person's name who completed the form."]
[null,"Program Contact:  Enter the person's name who is the program's contact."]
[null,"Email: Enter the program's electronic mail account."]
[null,"Phone: Enter the program's telephone number."]
[null,"Reporting Month and Year:  Enter the timeframe covered by the invoice. Enter date as mm/yy."]
["Consumer Monthly Information "]
[null,"Overall Average: Do not enter any data here! Data from all pages of consumer data in the fields will automatically calculate here once input."]
[null,"Total Consumer Hours Worked: This cell is calculated from data entered under the Hours Worked column.  Do not enter any data here! "]
[null,"Total Hours Job Coaching: This cell is calculated from data entered under the Hours of Job Coaching column.  Do not enter any data here! "]
[null,"% of Intervention: This cell is calculated from data entered under the % of Intervention column.  Do not enter any data here!  "]
[null,"Average Hourly Wage: This cell is calculated from data entered under the Hourly Wage column.  Do not enter any data here!  "]
[null,"Monthly Wage Total: This cell is calculated from data entered under the  Monthly Wage Total column.  Do not enter any data here! "]
["Consumer Data and Data Entry Columns"]
[null,"Last Name:  Enter the consumer's last name"]
[null,"First Ini:  Enter the initial of the consumer's first name."]
[null,"UCI #: Enter the consumer's seven digit UCI #.  If the UCI # entered is less than or more than 7 digits the field will remain light orange."]
[null,"Hours Worked: Enter the number of hours consumer worked during the month."]
[null,"Hours Job Coaching:  Enter the number of hours consumer received of job coaching during the month including travel time."]
[null,"Pre-Calculated Percentage of Intervention: Do not enter anything in this field it will be calculated automatically from the data in the Hours Worked and Hours of Job Coaching."]
[null,"Hourly Wage:  Enter the hourly wage consumer received while working during the month."]
[null,"Pre-Calculated Monthly Wage Total:  Do not enter anything in this field it will be calculated automatically from the data in the Hours Worked and Hourly Wage data."]
[null,"Funding Source & Program Type:  Choose Vocational Rehabilitaion (VR ) or Regional Center (RC) Funded based on IP program funding source. If the consumer is enrolled in the Paid Internship Program (PIP), choose PIP, to indicate that they are enrolled in the PIP. (Use drop down tab in the cell.)"]
[null,"Consumers Employer: Write in where the consumer is employed at. E.g. name of store/agency etc. "]
["Regional Center ID #:"]
[null,"Code","ABBRV","RC NAME"]
[null,360,"FDLRC","Frank D. Lanterman Regional Center"]
[null,361,"GGRC","Golden Gate Regional Center"]
[null,362,"SDRC","San Diego Regional Center"]
[null,363,"FNRC","Far Northern Regional Center"]
[null,364,"ACRC","Alta California Regional Center"]
[null,365,"SARC","San Andreas Regional Center"]
[null,366,"TCRC","Tri-Counties Regional Center"]
[null,367,"CVRC","Central Valley Regional Center"]
[null,368,"RCOC","Regional Center of Orange County"]
[null,369,"IRC","Inland Regional Center"]
[null,370,"RCRC","Redwood Coast Regional Center"]
[null,371,"NBRC","North Bay Regional Center"]
[null,372,"KRC","Kern Regional Center"]
[null,373,"ELARC","East Los Angeles Regional Center"]
[null,374,"SCLARC","South Central Los Angeles Regional Center"]
[null,375,"HRC","Harbor Regional Center"]
[null,376,"WRC","Westside Regional Center"]
[null,377,"VMRC","Valley Mountain Regional Center"]
[null,378,"NLACRC","North Los Angeles County Regional Center"]
[null,379,"SGPRC","San Gabriel/Pomona Regional Center"]
[null,380,"RCEB","Regional Center of the East Bay"]
["DOR Vocational Rehabilitation (VR) ID #:"]
[null,2218,"VR","DOR Vocational Rehabilitation"]
["Month Designations:"]
[null,"January","JA","April","AP","July",null,"JL","October",null,"OC"]
[null,"February","FE","May","MY","August",null,"AG","November",null,"NO"]
[null,"March","MR","June","JN","September",null,"SE","December",null,"DE"]

{"sheet":"DS 1972","index":1,"n_rows":446,"n_cols":11,"rows_kept":446,"cut":false,"hidden":false,"merged":[[3,0,3,10],[0,0,0,2],[0,3,0,10],[1,0,1,10],[2,0,2,4],[2,6,2,10],[9,0,9,3],[9,5,9,6],[9,7,9,8],[10,2,10,3],[10,4,10,5],[10,7,10,8],[4,0,4,10],[5,0,5,3],[5,4,5,6],[5,7,5,8],[6,0,7,3],[6,4,7,6],[6,7,6,8],[7,7,8,8],[8,0,8,3],[8,5,8,6],[11,0,11,8],[12,0,12,2],[12,3,12,4],[12,5,12,7],[11,9,17,9],[13,0,13,2],[13,3,13,4],[13,5,13,7],[16,0,16,8],[14,0,14,2],[14,3,14,4],[14,5,14,7],[15,0,15,2],[15,3,15,4],[15,5,15,7]]}
["State of California--Health and Human Services Agency",null,null,"Department of Developmental Services"]
["SUPPORTED EMPLOYMENT INDIVIDUAL PLACEMENT CONSUMER MONTHLY REPORT  "]
["DS 1972 SEP IP (Revised 10/2019) (Electronic Version)"]
[]
["Program Information"]
["PROGRAM NAME",null,null,null,"PROGRAM ADDRESS",null,null,"DATE (Mo/Yr):"]
[]
[null,null,null,null,null,null,null,"Regional Center Abbreviation"]
["PROGRAM CONTACT",null,null,null,"PHONE"]
[null,null,null,null,"EMAIL"]
["RC Vendor #: ",null,"Vendoring RC \nID#",null,null,null,"DOR Facility #: \n(Use if billing DOR)"]
["Consumer Monthly Information",null,null,null,null,null,null,null,null,"Funding Source &\nProgram Type\nChoose\nVR or RC Funded\nor \nPIP\n(Use drop down)"]
["Total Job Coaching Hours",null,null,{"$f":"IF(ISBLANK(B19),\"1\",SUM(F19:F498))","v":"1"},null,"Total Consumer Hours Worked",null,null,{"$f":"IF(ISBLANK(B19),\"1\",SUM(E19:E498))","v":"1"}]
["Ave % Intervention",null,null,{"$f":"IF(ISERROR(AVERAGE(G19:G446)),\"\",(AVERAGE(G19:G446)))","v":""},null," Average Hours Worked",null,null,{"$f":"IF(ISBLANK(B19),\"1\",AVERAGE(E19:E498))","v":"1"}]
[" Average Hourly Wage",null,null,{"$f":"IF(ISBLANK(H19),\"1\",AVERAGE(H19:H446))","v":"1"},null,"Average Monthly Wages",null,null,{"$f":"IF(ISERROR(AVERAGE(I19:I446)),\"\",(AVERAGE(I19:I446)))","v":""}]
["Total Monthly Wages",null,null,{"$f":"IF(ISBLANK(B19),\"1\",SUM(I19:I446))","v":"1"},null,"# of Consumers Served",null,null,{"$f":"COUNT(F19:F446)","v":0}]
["CONSUMER DATA"]
["INV SEQ NUM","LAST NAME","First\nInitial","UCI NUMBER","Hours Worked","Hours of Job Coaching","Percent of Intervention","Hourly Wage","Monthly Wage",null,"Consumer's Employer"]
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[2,null,null,null,null,null,"-1%",null," "]
[3,null,null,null,null,null,"-1%",null," "]
[4,null,null,null,null,null,"-1%",null," "]
[5,null,null,null,null,null,"-1%",null," "]
[6,null,null,null,null,null,"-1%",null," "]
[7,null,null,null,null,null,"-1%",null," "]
[8,null,null,null,null,null,"-1%",null," "]
[9,null,null,null,null,null,"-1%",null," "]
[10,null,null,null,null,null,"-1%",null," "]
[11,null,null,null,null,null,"-1%",null," "]
[12,null,null,null,null,null,"-1%",null,{"$f":"IF(ISBLANK(E30),\" \",E30*H30)","v":" "}]
[13,null,null,null,null,null,"-1%",null," "]
[14,null,null,null,null,null,"-1%",null," "]
[15,null,null,null,null,null,"-1%",null," "]
[16,null,null,null,null,null,"-1%",null," "]
[17,null,null,null,null,null,"-1%",null," "]
[18,null,null,null,null,null,"-1%",null," "]
[19,null,null,null,null,null,"-1%",null," "]
[20,null,null,null,null,null,"-1%",null," "]
[21,null,null,null,null,null,"-1%",null," "]
[22,null,null,null,null,null,"-1%",null," "]
[23,null,null,null,null,null,"-1%",null," "]
[24,null,null,null,null,null,"-1%",null," "]
[25,null,null,null,null,null,"-1%",null," "]
[26,null,null,null,null,null,"-1%",null," "]
[27,null,null,null,null,null,"-1%",null," "]
[28,null,null,null,null,null,"-1%",null," "]
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[36,null,null,null,null,null,"-1%",null," "]
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[38,null,null,null,null,null,"-1%",null," "]
[39,null,null,null,null,null,"-1%",null," "]
[40,null,null,null,null,null,"-1%",null," "]
[41,null,null,null,null,null,"-1%",null," "]
[42,null,null,null,null,null,"-1%",null," "]
[43,null,null,null,null,null,"-1%",null," "]
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[129,null,null,null,null,null,{"$f":"IF(ISBLANK(E147),\"-1%\",PRODUCT(F147/E147))","v":"-1%"},null," "]
[130,null,null,null,null,null,"-1%",null," "]
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