Questions about VR forms can be emailed to vrsm.support@twc.texas.gov.
VR Forms
Forms that state "PDF Signature" open a PDF form with a digital signature file.
PDF signature fields require a one-time digital signature creation step.
VR Forms
| Form | Form Title | Word | Excel | Instructions | Revised | |
|---|---|---|---|---|---|---|
| TWC1020 | TWC Substitute W-9 and Direct Deposit Form | PDF Instructions | 06/27/2018 | |||
| TWC1020-S | Forma W-9 Sustituta y de Depósito Directo del TWC | Instrucciones en PDF | 09/01/2016 | |||
| TWC1021 | Consumer or Parent Information and Direct Deposit | 08/01/2022 | ||||
| TWC1021-S | Información del Cliente o de los Padres/Guardas y de Depósito Directo | Instrucciones en PDF | 09/01/2016 | |||
| TWC1777 | Held Warrant Release Request | PDF Instructions | 12/01/2023 | |||
| VR1050 | Ticket to Work Partnership Plus—Employment Advancement Payment | Word | Word Instructions | 10/01/2017 | ||
| VR1200 | Provider Feedback | Word | Word Instructions | 09/01/2022 | ||
| VR1305 | Child Support Certification | Word | Word Instructions | 11/01/2017 | ||
| VR1307 | Background Checks Attestation and Release Form | Word | 05/15/2023 | |||
| VR1309 | Contractor Notice of Appeal Rights | Word | Word Instructions | 07/01/2021 | ||
| VR1487 | Designation of Applicant or Customer Representative | Word | 10/01/2017 | |||
| VR1487-S | Designación del Representante del Solicitante o Cliente | Word | 10/01/2017 | |||
| VR1505 | Request for Due-Process Hearing and/or Mediation | Word | PDF Signature | 06/01/2021 | ||
| VR1505-S | Solicitud para audiencia de proceso debido y/o mediación | Word | PDF Signature | 06/01/2021 | ||
| VR1512 | Benefits and Work Incentives Planning Referral | Word | 02/01/2023 | |||
| VR1600 | Work Experience Services Referral | Word | 06/01/2022 | |||
| VR1601 | Work Experience Plan and Placement Report | Word | 05/08/2024 | |||
| VR1604 | Work Experience Training Report | Word | 05/15/2023 | |||
| VR1609 | On-the-Job Training Worksheet | Word | 10/01/2024 | |||
| VR1629 | Referral for Career Planning Assessment (Replaced by VR5000) | 06/26/2023 | ||||
| VR1630 | Career Planning Assessment | Word | 02/01/2023 | |||
| VR1631 | Referral for Supported Employment Services (Replaced by VR5000) | 06/26/2023 | ||||
| VR1632 | Supported Employment Plan and Employment Report | Word | 02/01/2023 | |||
| VR1633 | Supported Employment Job Development and Job Analysis Report | Word | 02/01/2022 | |||
| VR1634 | Supported Employment Training Plan and Job Retention Report | Word | 02/01/2023 | |||
| VR1800 | Self-Employment Referral (Replaced by VR5000) | 06/26/2023 | ||||
| VR1801 | Customer Profile and Self-Employment Exploration | Word | 02/01/2023 | |||
| VR1802 | Concept Development and Feasibility Study | Word | 02/01/2023 | |||
| VR1803 | Self-Employment Simple Business Plan | Word | 10/01/2017 | |||
| VR1804 | Self-Employment Comprehensive Business Plan | Word | 10/01/2017 | |||
| VR1805-1 | Self-Employment Financial Projections Spreadsheet (Statutory Blindness) | Excel | 09/11/2024 | |||
| VR1805-2 | Self-Employment Financial Projections Spreadsheet | Excel | 09/11/2024 | |||
| VR1806 | Self-Employment Financial Actual Spreadsheet | Excel | 10/01/2017 | |||
| VR1808 | Supported Self-Employment Assessment (SSEA) | Word | 06/01/2022 | |||
| VR1809 | Supported Self-Employment Concept Development | Word | 02/01/2023 | |||
| VR1810 | Supported Self-Employment Feasibility Study | Word | 10/01/2017 | |||
| VR1811 | Supported Self-Employment Services Plan (SSESP) and Benchmark Report | Word | 02/01/2023 | |||
| VR1812 | Supported Self-Employment Business Plan Support Summary Report | Word | 02/01/2023 | |||
| VR1813 | Supported Self-Employment Business Plan | Word | 10/01/2017 | |||
| VR1814 | Supported Self-Employment Support Summary (SSE-SS) | Word | 02/01/2023 | |||
| VR1815 | Certified Business Technical Assistance Consultant (CBTAC) Support Summary Report | Word | 02/01/2023 | |||
| VR1820 | Request to Receive Pre-Employment Transition Services | Word | 12/01/2021 | |||
| VR1820-S | Solicitud para recibir servicios de transición previos al empleo | Word | 12/01/2021 | |||
| VR1823 | Pre-Employment Transition Services (Pre-ETS) Progress Report | Word | 02/01/2023 | |||
| VR1824 | Referral for Contracted Pre-Employment Transition Services (Pre-ETS) Services | Word | 02/01/2023 | |||
| VR1825 | Pre-ETS Curriculum Checklist | Word | 05/01/2023 | |||
| VR1836 | Vocational Evaluation Referral (Replaced by VR5000) | 06/26/2023 | ||||
| VR1837 | Report for Vocational Evaluation | Word | 02/01/2023 | |||
| VR1838 | Situational Assessment and Work Sample Report | Word | 02/01/2023 | |||
| VR1840 | Job Placement Services - Referral (Replaced by VR5000) | 06/26/2023 | ||||
| VR1841 | Non-Bundled Job Placement Services Data Sheet, Application, and Résumé Training | Word | 02/01/2023 | |||
| VR1842 | Non-Bundled Job Placement Services Interview Training Report | Word | 02/01/2023 | |||
| VR1845A | Bundled Job Placement Services Placement Plan Part A | Word | 02/01/2023 | |||
| VR1845B | Bundled Job Placement Services Plan Part B and Status Report | Word | 02/01/2023 | |||
| VR1846 | Bundled Job Placement Services Benchmark A Training Report | Word | 02/01/2023 | |||
| VR1850 | Employment Data Sheet | Word | 05/03/2021 | |||
| VR1877A | Environmental Work Assessment Report Part A | Word | Word Instructions | 10/01/2017 | ||
| VR1877B | Environmental Work Assessment Report Part B | Excel | 11/01/2017 | |||
| VR1877C | Environment Work Assessment Signature Page Part C | Word | 10/01/2020 | |||
| VR1878 | Environmental Work Assessment Time Log | Word | 10/01/2017 | |||
| VR1879 | Referral Form for Services for Neurodevelopmental Disorders | Word | 07/01/2021 | |||
| VR1880 | Autism Spectrum Disorder Supports Plan | Word | 11/01/2018 | |||
| VR1881 | Autism Spectrum Disorder Supports Time Log and Progress Report | Word | 10/01/2021 | |||
| VR1882 | Autism Service Premium Report | Word | 02/01/2023 | |||
| VR1883 | Blind Premium Report | Word | 11/01/2022 | |||
| VR1884 | Assistive Technology Services for Sight-Related Disabilities Referral | Word | 06/01/2022 | |||
| VR1886 | Assistive Technology Evaluation | Word | 02/01/2023 | |||
| VR1888 | Assistive Technology Training Results | Word | 02/01/2023 | |||
| VR1990 | Paid Work Experience Worksite Agreement | Word | 08/02/2021 | |||
| VR1990-S | Experiencia Laboral Remunerada Acuerdo sobre el lugar de trabajo | Word | 05/02/2022 | |||
| VR1991 | Referral for Embedded Pre-Employment Transition Services (Pre-ETS) (Replaced by VR5000) | 06/26/2023 | ||||
| VR1992 | Embedded Pre-Employment Transition Services (Pre-ETS) Progress Report | Word | 02/01/2023 | |||
| VR2006E | Interagency Eye Examination Report | Word | 10/01/2017 | |||
| VR2053 | Title IX Report Form | Word | 05/13/2024 | |||
| VR2180 | Maintenance Expense Log | Word | PDF Signature | 05/03/2021 | ||
| VR2180-S | Registro de gastos de mantenimiento | Word | PDF Signature | 05/03/2021 | ||
| VR2181 | Transportation Log | Word | PDF Signature | 05/03/2021 | ||
| VR2181-S | Registro de transporte | Word | PDF Signature | 05/03/2021 | ||
| VR2305 | Certificate of Medical Necessity Physician Order for Blood Pressure Monitor | Word | 09/03/2019 | |||
| VR2868 | Assistive Technology Training Report | Word | 02/01/2023 | |||
| VR2883 | Diabetes Self-Management Education Referral Form (Replaced by VR5000) | 06/26/2023 | ||||
| VR2884 | Diabetes Self-Management Educator Notes | Word | 02/01/2023 | |||
| VR2888 | Diabetes Self-Management Education Assessment | Word | 02/01/2023 | |||
| VR2889 | Diabetes Self-Management Education Services - Adaptive Diabetes Equipment Receipt | Word | 06/03/2019 | |||
| VR2891 | ILS-OIB Customer Services Progress Report | Word | 02/01/2023 | |||
| VR2894 | Orientation and Mobility Assessment | Word | 02/01/2023 | |||
| VR2896 | Orientation and Mobility Training | Word | 09/18/2023 | |||
| VR2897 | Orientation and Mobility Referral | Word | 10/01/2017 | |||
| VR2900 | Diabetes Self-Management Education Post Training Assessment | Word | 02/01/2023 | |||
| VR2901 | Diabetes Self-Management Education Pre- and Post-Assessment | Word | 02/01/2023 | |||
| VR2902 | Assistive Technology Training Baseline Assessments | Word | 06/01/2022 | |||
| VR2922 | Orientation and Mobility Weekly Internship Observation | Word | 10/01/2017 | |||
| VR2923 | Orientation and Mobility Internship Performance Evaluation | Word | 10/01/2017 | |||
| VR2954 | Comprehensive Assessment for ILS-OIB Program | Word | 02/01/2023 | |||
| VR3100 | General Physical Examination Report | Word | 10/01/2017 | |||
| VR3101 | Consultant Review | Word | PDF Signature | 06/01/2021 | ||
| VR3102 | Pulmonary Evaluation Report | Word | 11/01/2017 | |||
| VR3103 | Cardiac Evaluation Report | Word | Word Instructions | 11/01/2017 | ||
| VR3104 | Acknowledgement for Noncertified Interpreter | Word | PDF Signature | 04/01/2022 | ||
| VR3105A | Hearing Evaluation Report: Customer Questionnaire | Word | 10/01/2017 | |||
| VR3105A-S | Informe de evaluación de la audición: Cuestionario para el cliente | Word | 10/01/2017 | |||
| VR3105B | Hearing Evaluation Report: Otological Examination | Word | PDF Signature | 06/01/2022 | ||
| VR3105C | Hearing Evaluation Report: Audiometric Examination | Word | PDF Signature | 10/01/2017 | ||
| VR3105D | Hearing Evaluation Report: Hearing Aid Recommendations | Word | PDF Signature | 01/16/2024 | ||
| VR3105E | Hearing Aid Fitting and Post-Fitting Report | Word | 01/15/2021 | |||
| VR3105F | Hearing Aid and Hearing Aid Accessories Return | Word | 06/01/2022 | |||
| VR3105G | Hearing Aid and Accessories Loss/Damage Replacement Request | Word | 01/16/2024 | |||
| VR3106 | Work Restriction Checklist | Word | Word Instructions | 11/01/2017 | ||
| VR3108 | Dental Report | Word | Word Instructions | 11/01/2017 | ||
| VR3109 | Eye Surgery and Treatment Recommendations | Word | 12/01/2020 | |||
| VR3110 | Surgery and Treatment Recommendations | Word | PDF Signature | 08/27/2018 | ||
| VR3111 | End-Stage Renal Disease Evaluation | Word | Word Instructions | 11/01/2017 | ||
| VR3112 | Cancer/Diabetes Disability Medical Report | Word | 08/01/2022 | |||
| VR3118 | Hospital Facility Information | Word | 06/01/2021 | |||
| VR3121 | Referral for Personal Social Adjustment Training and Work Adjustment Training | Word | 06/26/2023 | |||
| VR3122 | Vocational Adjustment Training (VAT): Explore the "You" in Work | Word | 02/01/2023 | |||
| VR3123 | Vocational Adjustment Training (VAT): Soft Skills for Work Success | Word | 02/01/2023 | |||
| VR3124 | Vocational Adjustment Training (VAT): Soft Skills to Pay the Bills | Word | 02/01/2023 | |||
| VR3125 | Vocational Adjustment Training (VAT): Entering the World of Work | Word | 02/01/2023 | |||
| VR3126 | Vocational Adjustment Training (VAT): Job Search Training | Word | 02/01/2023 | |||
| VR3132 | Vocational Adjustment Training (VAT): Disability Disclosure Training | Word | 02/01/2023 | |||
| VR3133 | Vocational Adjustment Training (VAT): Money Smart | Word | 02/01/2023 | |||
| VR3134 | Vocational Adjustment Training (VAT): Public Transportation Training | Word | 05/15/2023 | |||
| VR3135A | Vocational Adjustment Training Specialized Evaluation | Word | 02/01/2023 | |||
| VR3135B | Vocational Training Specialized Training Plan | Word | 02/01/2023 | |||
| VR3136 | Vocational Adjustment Training Specialized Progress Report | Word | 02/01/2023 | |||
| VR3137A | Personal Social Adjustment Training and Work Adjustment Training Evaluation | Word | 02/01/2023 | |||
| VR3137B | Personal Social Adjustment and Work Adjustment Training Plan | Word | 02/01/2023 | |||
| VR3138 | Personal Social Adjustment Training and Work Adjustment Training Report | Word | 02/01/2023 | |||
| VR3139 | Vocational Adjustment Training (VAT): Exploring Postsecondary Education and Training | Word | 02/01/2023 | |||
| VR3141 | Referral for Wage Services - WorkQuest | Word | 11/01/2021 | |||
| VR3142 | Worksite Agreement for Wage Services - WorkQuest | Word | 11/01/2023 | |||
| VR3314 | Job Skills Training Referral | Word | 02/01/2023 | |||
| VR3315 | Job Skills Training Progress Report | Word | 02/01/2023 | |||
| VR3316 | On-the-Job Training Progress Report | Word | 07/01/2021 | |||
| VR3321 | Proprietary School Training Information | Word | 11/01/2017 | |||
| VR3360 | Referral for Project SEARCH (Replaced by VR5000) | 06/26/2023 | ||||
| VR3361 | Project SEARCH Asset Discovery Report | Word | 02/01/2023 | |||
| VR3362 | Project SEARCH Progress Report | Word | 02/01/2023 | |||
| VR3363 | Project SEARCH Job Placement Services Plan | Word | 06/01/2024 | |||
| VR3364 | Project SEARCH Placement Report | Word | 02/01/2023 | |||
| VR3380 | Referral for Wellness Recovery Action Plan (WRAP) (Replaced by VR5000) | 06/26/2023 | ||||
| VR3381 | Wellness Recovery Action Plan (WRAP) Services Summary and Recommendations | Word | 07/01/2021 | |||
| VR3383 | Supportive Residential Referral Form (Replaced by VR5000) | 06/26/2023 | ||||
| VR3384 | Supportive Residential Services (SRS) Progress Report | Word | 02/01/2023 | |||
| VR3385 | VR Provision of Other VR Services Certification | Word | 06/12/2024 | |||
| VR3405 | Tuition Payment Calculation Worksheet for Private or Out-of-State Training | Word | 07/20/2023 | |||
| VR3406 | Counseling Progress Report | Word | Word Instructions | 11/01/2017 | ||
| VR3407 | Training Progress Report | Word | 11/01/2017 | |||
| VR3408 | Vehicle Modification Evaluation | Word | 12/01/2020 | |||
| VR3415 | Workers' Compensation Contact Verification Letter | Word | Word Instructions | 11/01/2023 | ||
| VR3420 | Employment Support for Brain Injury - Referral (Replaced by VR5000) | 06/26/2023 | ||||
| VR3422 | Reduced Payment Agreement | Word | 11/01/2017 | |||
| VR3433 | Mileage Premium Report | Word | 01/02/2019 | |||
| VR3434 | Provider Travel Plan and Report | Word | 03/15/2018 | |||
| VR3436 | Travel Premium Plan and Report | Word | 05/03/2021 | |||
| VR3437 | Hearing Aids and Accessories Certification | Word | 06/01/2022 | |||
| VR3438 | Vehicle Modification Certification | Word | 02/08/2021 | |||
| VR3439 | Durable Medical Equipment Certification | Word | 02/08/2021 | |||
| VR3440A | Goods and Equipment Part A - Parent Company Information | Word | 02/08/2021 | |||
| VR3440B | Goods and Equipment Part B - Local Business Location Information | Word | 12/01/2022 | |||
| VR3441A | Entity Headquarters Information Part A - Management Team | Word | 03/02/2020 | |||
| VR3441B | Entity Headquarters Information Part B - Services | Word | 04/01/2023 | |||
| VR3441C | Entity Headquarters Information Part C - Locations | Word | 12/01/2020 | |||
| VR3442A | Provider Physical Locations Part A - Certification Statement | Word | 12/01/2022 | |||
| VR3442B | Provider Physical Locations Part B - General Information | Word | 12/01/2022 | |||
| VR3443 | TWC VR Standards for Providers Certification | Word | 03/02/2020 | |||
| VR3444 | TWC VR Conflict of Interest Certification | Word | 03/02/2020 | |||
| VR3445 | Provider Insurance Verification | Word | 03/02/2020 | |||
| VR3446 | VR Incident Report | Word | 02/01/2023 | |||
| VR3448 | Employment Supports for Brain Injury - Provider Information and Acknowledgements | Word | 02/01/2023 | |||
| VR3449 | Employment Supports for Brain Injury - Professional Staff | Word | 08/01/2024 | |||
| VR3454 | Benefits Counseling Provider Staff Information Form | Word | 08/01/2022 | |||
| VR3455 | Provider Staff Information Form | Word | 11/01/2023 | |||
| VR3472 | Contracted Service Modification Request | Word | 02/01/2023 | |||
| VR3472 | Contracted Service Modification Request for Blind and Visually Impaired Services | Word | 02/01/2023 | |||
| VR3472 | Contracted Service Modification Request for Job Placement, Job Skills Training, and Supported Employment Services | Word | 02/01/2023 | |||
| VR3472 | Contracted Service Modification Request for Project SEARCH Services | Word | 02/01/2023 | |||
| VR3472 | Contracted Service Modification Request for Vocational Assessments | Word | 02/01/2023 | |||
| VR3472 | Contracted Service Modification Request for Work Experience Services | Word | 02/01/2023 | |||
| VR3472 | Contracted Service Modification Request for Work Readiness Services | Word | 02/01/2023 | |||
| VR3473 | Customer Orientation Checklist for VR Service Providers | Word | 02/01/2023 | |||
| VR3490 | Temporary Waiver of Credentials | Word | 06/01/2022 | |||
| VR3494 | Mechanic's Evaluation - Used Vehicle | Word | 11/01/2017 | |||
| VR5000 | Referral for Provider Services | Word | 06/26/2023 | |||
| VR5053 | Application Statement for OIB Program | Word | 12/20/2023 | |||
| VR5053-S | Declaración de Solicitud para el Programa de OIB | Word | 12/20/2023 | |||
| VR5056 | Application for Vocational Rehabilitation Services | Word | 09/18/2023 | |||
| VR5056-S | Solicitud para Servicios Vocacionales de Rehabilitación | Word | 09/18/2023 | |||
| VR5110 | Refusal to Participate in TWS-VRS WIOA Section 511 Required Activities | Word | 10/01/2017 | |||
| VR5110-S | Rehusar Participar en Actividades Requeridas de TWS-VRS WIOA Sección 511 | Word | 10/01/2017 | |||
| VR5111 | Guardian Cover Letter | Word | 11/01/2023 | |||
| VR5111-S | Hoja de presentación del tutor | Word | 11/01/2023 | |||
| VR5112 | Career Counseling Datasheet | Word | 10/01/2017 | |||
| VR5112-S | Hoja de Datos de Asesoría para Carreras | Word | 10/01/2017 | |||
| VR5113 | Career Counseling and Information and Referral for Individuals – Subminimum Wage | Word | 05/01/2024 | |||
| VR5113-S | Orientación profesional e información y remisión para individuos - Salario inferior al mínimo | Word | 05/01/2024 | |||
| VR5115 | TWS-VRS Career Counseling Workbook | Word | 05/08/2024 | |||
| VR5115-S | TWC VRS Libro de Trabajo de Asesoría para Carreras | Word | 05/08/2024 | |||
| VR5118 | Section 511 Cover Sheet for Group Three | Word | 07/03/2018 | |||
| VR5118-S | Fracción 511 Hoja de Presentación para Grupo Tres | Word | 07/03/2018 | |||
| VR5159 | Individualized Plan for Employment (IPE) Amendment | Word | 09/18/2023 | |||
| VR5159-S | Plan Individualizado de Empleo (IPE) Enmendado | Word | 09/18/2023 | |||
| VR5163 | Individualized Plan for Employment (IPE) | Word | 09/18/2023 | |||
| VR5163-S | Plan de empleo individualizado | Word | 09/18/2023 |