Form Ovr 172 PDF Details

In today's world, navigating the terrain of vocational rehabilitation and developmental programs can seem daunting, yet the OVR-172 form serves as a critical bridge in this journey. Crafted by the Pennsylvania Department of Labor & Industry's Office of Vocational Rehabilitation in collaboration with the Office of Developmental Programs, this interagency referral form is a cornerstone for initiating a collaborative process aimed at enhancing the vocational rehabilitation services for individuals with disabilities. The form, updated in May 2014, is designed to streamline the referral process, ensuring seamless communication between the two offices. It encompasses vital information including the referral's personal details, diagnoses, contact information, and if applicable, details of their designated representative. Moreover, it outlines the expectations for the exchange of critical documents such as medical, psychological, educational records, vocational evaluations, and assessments which are imperative for crafting an individualized plan for employment. The OVR-172 form not only emphasizes the partnership between the referring agency and vocational rehabilitation services but also underscores the commitment to providing an equitable opportunity for every individual to achieve their vocational goals. It stands as a testament to the collaborative spirit, aiming to ensure that the right aids and services are rendered to those in need, thereby fostering an environment of inclusion and equal opportunity.

QuestionAnswer
Form NameForm Ovr 172
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesovr form, ovr forms, ovr online, ovr online application

Form Preview Example

OVR-172

Rev 5/14

Department of Labor & Industry

Office of Vocational Rehabilitation

OVR-ODP INTERAGENCY REFERRAL FORM

(To be utilized by the PA Office of Vocational Rehabilitation and the Office of Developmental Programs)

Referral Information:

Name:

 

 

 

 

 

 

 

 

 

 

 

DOB:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Diagnoses:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Physical Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address (if different):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone- Home:

 

 

 

Cell:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Email:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Designated Representative (if applicable):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name:

 

 

 

 

 

 

 

 

 

 

 

Relation:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone- Home:

 

 

 

 

 

Cell:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Email:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Work:

Work:

Referring Agency (Check one):

Representative’s Name:

Office Address:

Phone:

Email:

ODP

OVR

Days in Office:

M

Tu

W

Th

Does the agency want to be notified when the Intake Interview is scheduled?

To whom information/application should be sent, or initial contact should be made:

Individual

Designated Representative Referring Agency Representative

Documents attached: ODP

ISP Employment Supplement

Medical/psychological/educational records

Vocational Evaluations/Assessments

Other:

F Time:

YES NO

OVR

Individualized Plan for Employment (IPE) Medical/psychological/educational records

Vocational Evaluations/Assessments

Other:

__________________________________ _______________________

Referring Agency Signature

Date

 

Auxiliary aids and services are available upon request to individuals with disabilities.

 

Equal Opportunity Employer/Program

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2. Just after the first array of blanks is done, go to enter the relevant details in these - Referring Agency Check one, ODP, OVR, Representatives Name, Office Address, Phone, Email, Days in Office, Time, Does the agency want to be, YES, To whom informationapplication, Individual, Designated Representative, and Referring Agency Representative.

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