Form Ddd 1404Aforpf PDF Details

In the realm of supporting individuals with developmental disabilities in their employment journey, the Arizona Department of Economic Security's Division of Developmental Disabilities (DDD) has devised a critical tool, the DDD-1404AFORPF form. This form serves as a monthly progress report, a comprehensive document designed to bridge communication between employment support aides, employers, and the DDD. Its primary function is to track the assistance provided to consumers, including the total hours worked, the hourly rate, and the type of support received, whether it be personal care services, individual or group supported employment, or behavioral supports, among other categories. The form carefully outlines objectives and progress in accordance with the consumer's Individual Support Plan, identifying any barriers faced and planning necessary actions to overcome them. Additionally, the employment support aide logs detailed summaries of services rendered, ensuring a transparent and accountable support system. This tool not only facilitates a structured approach to employment support but also underscores the department's commitment to equal opportunity employment and the provision of reasonable accommodations as mandated by federal laws, ensuring that every individual with a developmental disability has the support and opportunity to thrive in their employment endeavors.

QuestionAnswer
Form NameForm Ddd 1404Aforpf
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesDDD 1404AFORPF arizona department of economic security supported employment form ddd 1403aforpf 12 06

Form Preview Example

DDD-1404AFORPF (12-06) - Page 1 of 2

 

ARIZONA DEPARTMENT OF ECONOMIC SECURITY

 

Division of Developmental Disabilities (DDD)

 

Employment Supports & Services

 

MONTHLY PROGRESS REPORT

Please print

Employment Support Aide

MONTH/YEAR

 

QUALIFIED VENDOR’S NAME

 

 

 

 

 

 

PHONE NUMBER (Include area code)

 

 

 

 

 

 

 

 

 

 

 

 

QUALIFIED VENDOR’S ADDRESS (P.O. Box, No., Street, City, State, ZIP)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONSUMER’S NAME (Last, First, M.I.)

 

EMPLOYMENT PROGRAM SPECIALIST’S NAME

 

 

 

 

 

 

 

 

 

 

 

 

SUPPORT COORDINATOR’S NAME

 

 

 

 

DDD I.D. NO.

 

 

 

 

 

 

 

 

 

 

 

 

 

EMPLOYER’S NAME

 

 

 

 

 

 

PHONE NUMBER (Include area code)

 

 

 

 

 

 

 

 

 

 

EMPLOYER’S ADDRESS (P.O. Box, No., Street, City, State, ZIP)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUPERVISOR/CONTACT PERSON’S NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONSUMER’S JOB TITLE

 

 

 

 

 

 

 

HIRE DATE

 

 

 

 

 

 

 

 

 

WEEKLY WORK SCHEDULE

 

 

TOTAL HOURS WORKED THIS MONTH

HOURLY RATE

 

 

 

 

 

 

 

 

 

 

 

SERVICE SETTING

TYPE OF SUPPORT

 

MONTHLY HOURS

MONTHLY HOURS

 

 

AUTHORIZED

PROVIDED

 

 

 

 

 

 

 

 

Center-Based Employment

Personal Care Services

 

 

 

 

 

 

 

 

 

 

 

 

 

Group Supported Employment

 

 

 

 

 

 

 

Behavioral Supports

 

 

 

 

 

 

Individual Supported Employment

(not available in Center-Based Employment)

 

 

 

 

 

 

Job-related supports

 

 

 

 

 

 

 

 

 

 

 

 

 

Follow-Along Services

(only available in follow-along)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BEHAVIORAL INTERVENTION

Objective as stated in the Individual Support Plan:

Progress made on listed outcome(s)/objectives. If no progress, identify barriers and list plan of action.

FOLLOW-ALONG SERVICES

Objective as stated in the Individual Support Plan:

Progress made on listed outcome(s)/objectives. If no progress, identify barriers and list plan of action.

DDD-1404AFORPF (12-06) Page 2 of 2

EMPLOYMENT SUPPORT AIDE SERVICE LOG

Provide a detailed summary of services rendered, including a description of personal care activities, behavioral supports and job-related supports. Each contact entry must be signed by the Employment Support Aide. Attach additional sheets as necessary.

Date

Service Hours

Summary of Services Rendered

Employment Support Aide’s

Signature

QUALIFIED VENDOR ADMINISTRATOR/DESIGNEE’S NAME

QUALIFIED VENDOR ADMINISTRATOR/DESIGNEE’S TITLE

QUALIFIED VENDOR ADMINISTRATOR/DESIGNEE’S SIGNATURE

DATE

Routing: Original – Support Coordinator, Copy – District File

Equal Opportunity Employer/Program • Under Titles VI and VII of the Civil Rights Act of 1964, and the Americans with Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act of 1973, and the Age Discrimination Act of 1975, the Department prohibits discrimination in admissions, programs, services, activities, or employment based on race, color, religion, sex, national origin, age, and disability. The Department must make a reasonable accommodation to allow a person with a disability to take part in a program, service or activity. For example, this means if necessary, the Department must provide sign language interpreters for people who are deaf, a wheelchair accessible location, or enlarged print materials. It also means that the Department will take any other reasonable action that allows you to take part in and understand a program or activity, including making reasonable changes to an activity. If you believe that you will not be able to understand or take part in a program or activity because of your disability, please let us know of your disability needs in advance if at all possible. To request this document in alternative format or for further information about this policy, contact the Division of Developmental Disabilities ADA Coordinator at (602) 542-6825; TTY/TDD Services: 7-1-1.

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With regards to the blank fields of this specific document, here is what you need to do:

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Stage no. 1 of filling in Form Ddd 1404Aforpf

2. After this array of fields is complete, it is time to add the needed particulars in Group Supported Employment, Individual Supported Employment, FollowAlong Services, Behavioral Supports, not available in CenterBased, Jobrelated supports, only available in followalong, BEHAVIORAL INTERVENTION, Objective as stated in the, Progress made on listed, Objective as stated in the, Progress made on listed, and FOLLOWALONG SERVICES so you're able to progress further.

Writing segment 2 of Form Ddd 1404Aforpf

3. This next section is mostly about Date, Service Hours, Summary of Services Rendered, Employment Support Aides, and Signature - fill in each one of these blanks.

Signature, Summary of Services Rendered, and Date in Form Ddd 1404Aforpf

A lot of people often make errors while filling out Signature in this section. Be sure you review what you type in here.

4. To move forward, this next part requires completing a handful of blank fields. Examples of these are QUALIFIED VENDOR, QUALIFIED VENDOR, QUALIFIED VENDOR, DATE, and Routing Original Support, which are vital to going forward with this particular process.

Routing Original Support, DATE, and QUALIFIED VENDOR of Form Ddd 1404Aforpf

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