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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 TitleWordExcelPDFInstructionsRevised  
TWC1020TWC Substitute W-9 and Direct Deposit Form  PDFPDF Instructions06/27/2018
TWC1020-SForma W-9 Sustituta y de Depósito Directo del TWC  PDFInstrucciones en PDF09/01/2016
TWC1021Consumer or Parent Information and Direct Deposit  PDF 08/01/2022
TWC1021-SInformación del Cliente o de los Padres/Guardas y de Depósito Directo  PDFInstrucciones en PDF09/01/2016
TWC1777Held Warrant Release Request  PDFPDF Instructions12/01/2023
VR1050Ticket to Work Partnership Plus—Employment Advancement PaymentWord  Word Instructions10/01/2017
VR1200Provider FeedbackWord  Word Instructions09/01/2022
VR1211Provider ApplicationWord   10/01/2017
VR1305Child Support CertificationWord  Word Instructions11/01/2017
VR1307Background Checks Attestation and Release FormWord   05/15/2023
VR1309Contractor Notice of Appeal RightsWord  Word Instructions07/01/2021
VR1487Designation of Applicant or Customer RepresentativeWord   10/01/2017
VR1487-SDesignación del Representante del Solicitante o ClienteWord   10/01/2017
VR1505Request for Due-Process Hearing and/or MediationWord PDF Signature 06/01/2021
VR1505-SSolicitud para audiencia de proceso debido y/o mediaciónWord PDF Signature 06/01/2021
VR1512Benefits and Work Incentives Planning ReferralWord   02/01/2023
VR1600Work Experience Services ReferralWord   06/01/2022
VR1601Work Experience Plan and Placement ReportWord   05/08/2024
VR1604Work Experience Training ReportWord   05/15/2023
VR1609On-the-Job Training WorksheetWord   10/13/2021
VR1629Referral for Career Planning Assessment (Replaced by VR5000)    06/26/2023
VR1630Career Planning AssessmentWord   02/01/2023
VR1631Referral for Supported Employment Services (Replaced by VR5000)    06/26/2023
VR1632Supported Employment Plan and Employment ReportWord   02/01/2023
VR1633Supported Employment Job Development and Job Analysis ReportWord   02/01/2022
VR1634Supported Employment Training Plan and Job Retention ReportWord   02/01/2023
VR1800Self-Employment Referral (Replaced by VR5000)    06/26/2023
VR1801Customer Profile and Self-Employment ExplorationWord   02/01/2023
VR1802Concept Development and Feasibility StudyWord   02/01/2023
VR1803Self-Employment Simple Business PlanWord   10/01/2017
VR1804Self-Employment Comprehensive Business PlanWord   10/01/2017
VR1805-1Self-Employment Financial Projections Spreadsheet (Statutory Blindness) Excel  12/01/2022
VR1805-2Self-Employment Financial Projections Spreadsheet Excel  12/01/2022
VR1806Self-Employment Financial Actual Spreadsheet Excel  10/01/2017
VR1808Supported Self-Employment Assessment (SSEA)Word   06/01/2022
VR1809Supported Self-Employment Concept DevelopmentWord   02/01/2023
VR1810Supported Self-Employment Feasibility StudyWord   10/01/2017
VR1811Supported Self-Employment Services Plan (SSESP) and Benchmark ReportWord   02/01/2023
VR1812Supported Self-Employment Business Plan Support Summary ReportWord   02/01/2023
VR1813Supported Self-Employment Business PlanWord   10/01/2017
VR1814Supported Self-Employment Support Summary (SSE-SS)Word   02/01/2023
VR1815Certified Business Technical Assistance Consultant (CBTAC) Support Summary ReportWord   02/01/2023
VR1820Request to Receive Pre-Employment Transition ServicesWord   12/01/2021
VR1820-SSolicitud para recibir servicios de transición previos al empleoWord   12/01/2021
VR1823Pre-Employment Transition Services (Pre-ETS) Progress ReportWord   02/01/2023
VR1824Referral for Contracted Pre-Employment Transition Services (Pre-ETS) ServicesWord   02/01/2023
VR1825Pre-ETS Curriculum ChecklistWord   05/01/2023
VR1836Vocational Evaluation Referral (Replaced by VR5000)    06/26/2023
VR1837Report for Vocational EvaluationWord   02/01/2023
VR1838Situational Assessment and Work Sample ReportWord   02/01/2023
VR1840Job Placement Services - Referral (Replaced by VR5000)    06/26/2023
VR1841Non-Bundled Job Placement Services Data Sheet, Application, and Résumé TrainingWord   02/01/2023
VR1842Non-Bundled Job Placement Services Interview Training ReportWord   02/01/2023
VR1845ABundled Job Placement Services Placement Plan Part AWord   02/01/2023
VR1845BBundled Job Placement Services Plan Part B and Status ReportWord   02/01/2023
VR1846Bundled Job Placement Services Benchmark A Training ReportWord   02/01/2023
VR1850Employment Data SheetWord   05/03/2021
VR1877AEnvironmental Work Assessment Report Part AWord  Word Instructions10/01/2017
VR1877BEnvironmental Work Assessment Report Part B Excel  11/01/2017
VR1877CEnvironment Work Assessment Signature Page Part CWord   10/01/2020
VR1878Environmental Work Assessment Time LogWord   10/01/2017
VR1879Referral Form for Services for Neurodevelopmental DisordersWord   07/01/2021
VR1880Autism Spectrum Disorder Supports PlanWord   11/01/2018
VR1881Autism Spectrum Disorder Supports Time Log and Progress ReportWord PDF 10/01/2021
VR1882Autism Service Premium ReportWord   02/01/2023
VR1883Blind Premium ReportWord   11/01/2022
VR1884Assistive Technology Services for Sight-Related Disabilities ReferralWord   06/01/2022
VR1886Assistive Technology EvaluationWord   02/01/2023
VR1888Assistive Technology Training ResultsWord   02/01/2023
VR1990Paid Work Experience Worksite AgreementWord   08/02/2021
VR1990-SExperiencia Laboral Remunerada Acuerdo sobre el lugar de trabajoWord   05/02/2022
VR1991Referral for Embedded Pre-Employment Transition Services (Pre-ETS) (Replaced by VR5000)    06/26/2023
VR1992Embedded Pre-Employment Transition Services (Pre-ETS) Progress ReportWord   02/01/2023
VR2006EInteragency Eye Examination ReportWord   10/01/2017
VR2053Title IX Report FormWord   05/13/2024
VR2180Maintenance Expense LogWord PDF Signature 05/03/2021
VR2180-SRegistro de gastos de mantenimientoWord PDF Signature 05/03/2021
VR2181Transportation LogWord PDF Signature 05/03/2021
VR2181-SRegistro de transporteWord PDF Signature 05/03/2021
VR2305Certificate of Medical Necessity Physician Order for Blood Pressure MonitorWord   09/03/2019
VR2868Assistive Technology Training ReportWord   02/01/2023
VR2883Diabetes Self-Management Education Referral Form (Replaced by VR5000)    06/26/2023
VR2884Diabetes Self-Management Educator NotesWord   02/01/2023
VR2888Diabetes Self-Management Education AssessmentWord   02/01/2023
VR2889Diabetes Self-Management Education Services - Adaptive Diabetes Equipment ReceiptWord   06/03/2019
VR2891ILS-OIB Customer Services Progress ReportWord   02/01/2023
VR2894Orientation and Mobility AssessmentWord   02/01/2023
VR2896Orientation and Mobility TrainingWord   09/18/2023
VR2897Orientation and Mobility ReferralWord   10/01/2017
VR2900Diabetes Self-Management Education Post Training AssessmentWord   02/01/2023
VR2901Diabetes Self-Management Education Pre- and Post-AssessmentWord   02/01/2023
VR2902Assistive Technology Training Baseline AssessmentsWord   06/01/2022
VR2922Orientation and Mobility Weekly Internship ObservationWord   10/01/2017
VR2923Orientation and Mobility Internship Performance EvaluationWord   10/01/2017
VR2954Comprehensive Assessment for ILS-OIB ProgramWord   02/01/2023
VR3100General Physical Examination ReportWord   10/01/2017
VR3101Consultant ReviewWord PDF Signature 06/01/2021
VR3102Pulmonary Evaluation ReportWord   11/01/2017
VR3103Cardiac Evaluation ReportWord  Word Instructions11/01/2017
VR3104Acknowledgement for Noncertified InterpreterWord PDF Signature 04/01/2022
VR3105AHearing Evaluation Report: Customer QuestionnaireWord   10/01/2017
VR3105A-SInforme de evaluación de la audición: Cuestionario para el clienteWord   10/01/2017
VR3105BHearing Evaluation Report: Otological ExaminationWord PDF Signature 06/01/2022
VR3105CHearing Evaluation Report: Audiometric ExaminationWord PDF Signature 10/01/2017
VR3105DHearing Evaluation Report: Hearing Aid RecommendationsWord PDF Signature 01/16/2024
VR3105EHearing Aid Fitting and Post-Fitting ReportWord   01/15/2021
VR3105FHearing Aid and Hearing Aid Accessories ReturnWord   06/01/2022
VR3105GHearing Aid and Accessories Loss/Damage Replacement RequestWord   01/16/2024
VR3106Work Restriction ChecklistWord  Word Instructions11/01/2017
VR3108Dental ReportWord  Word Instructions11/01/2017
VR3109Eye Surgery and Treatment RecommendationsWord   12/01/2020
VR3110Surgery and Treatment RecommendationsWord PDF Signature 08/27/2018
VR3111End-Stage Renal Disease EvaluationWord  Word Instructions11/01/2017
VR3112Cancer/Diabetes Disability Medical ReportWord   08/01/2022
VR3118Hospital Facility InformationWord   06/01/2021
VR3121Referral for Personal Social Adjustment Training and Work Adjustment TrainingWord   06/26/2023
VR3122Vocational Adjustment Training (VAT): Explore the "You" in WorkWord   02/01/2023
VR3123Vocational Adjustment Training (VAT): Soft Skills for Work SuccessWord   02/01/2023
VR3124Vocational Adjustment Training (VAT): Soft Skills to Pay the BillsWord   02/01/2023
VR3125Vocational Adjustment Training (VAT): Entering the World of WorkWord   02/01/2023
VR3126Vocational Adjustment Training (VAT): Job Search TrainingWord   02/01/2023
VR3132Vocational Adjustment Training (VAT): Disability Disclosure TrainingWord   02/01/2023
VR3133Vocational Adjustment Training (VAT): Money SmartWord   02/01/2023
VR3134Vocational Adjustment Training (VAT): Public Transportation TrainingWord   05/15/2023
VR3135AVocational Adjustment Training Specialized EvaluationWord   02/01/2023
VR3135BVocational Training Specialized Training PlanWord   02/01/2023
VR3136Vocational Adjustment Training Specialized Progress ReportWord   02/01/2023
VR3137APersonal Social Adjustment Training and Work Adjustment Training EvaluationWord   02/01/2023
VR3137BPersonal Social Adjustment and Work Adjustment Training PlanWord   02/01/2023
VR3138Personal Social Adjustment Training and Work Adjustment Training ReportWord   02/01/2023
VR3139Vocational Adjustment Training (VAT): Exploring Postsecondary Education and TrainingWord   02/01/2023
VR3141Referral for Wage Services - WorkQuestWord   11/01/2021
VR3142Worksite Agreement for Wage Services - WorkQuestWord   11/01/2023
VR3314Job Skills Training ReferralWord   02/01/2023
VR3315Job Skills Training Progress ReportWord   02/01/2023
VR3316On-the-Job Training Progress ReportWord   07/01/2021
VR3321Proprietary School Training InformationWord   11/01/2017
VR3360Referral for Project SEARCH (Replaced by VR5000)    06/26/2023
VR3361Project SEARCH Asset Discovery ReportWord   02/01/2023
VR3362Project SEARCH Progress ReportWord   02/01/2023
VR3363Project SEARCH Job Placement Services PlanWord   02/01/2023
VR3364Project SEARCH Placement ReportWord   02/01/2023
VR3380Referral for Wellness Recovery Action Plan (WRAP) (Replaced by VR5000)    06/26/2023
VR3381Wellness Recovery Action Plan (WRAP) Services Summary and RecommendationsWord   07/01/2021
VR3383Supportive Residential Referral Form (Replaced by VR5000)    06/26/2023
VR3384Supportive Residential Services (SRS) Progress ReportWord   02/01/2023
VR3405Tuition Payment Calculation Worksheet for Private or Out-of-State TrainingWord   07/20/2023
VR3406Counseling Progress ReportWord  Word Instructions11/01/2017
VR3407Training Progress ReportWord   11/01/2017
VR3408Vehicle Modification EvaluationWord   12/01/2020
VR3415Workers' Compensation Contact Verification LetterWord  Word Instructions11/01/2023
VR3420Employment Support for Brain Injury - Referral (Replaced by VR5000)    06/26/2023
VR3422Reduced Payment AgreementWord   11/01/2017
VR3433Mileage Premium ReportWord   01/02/2019
VR3434Provider Travel Plan and Report Word   03/15/2018
VR3436Travel Premium Plan and ReportWord   05/03/2021
VR3437Hearing Aids and Accessories CertificationWord   06/01/2022
VR3438Vehicle Modification CertificationWord   02/08/2021
VR3439Durable Medical Equipment CertificationWord   02/08/2021
VR3440AGoods and Equipment Part A - Parent Company InformationWord   02/08/2021
VR3440BGoods and Equipment Part B - Local Business Location InformationWord   12/01/2022
VR3441AEntity Headquarters Information Part A - Management TeamWord   03/02/2020
VR3441BEntity Headquarters Information Part B - ServicesWord   04/01/2023
VR3441CEntity Headquarters Information Part C - LocationsWord   12/01/2020
VR3442AProvider Physical Locations Part A - Certification StatementWord   12/01/2022
VR3442BProvider Physical Locations Part B - General InformationWord   12/01/2022
VR3443TWC VR Standards for Providers CertificationWord   03/02/2020
VR3444TWC VR Conflict of Interest CertificationWord   03/02/2020
VR3445Provider Insurance VerificationWord   03/02/2020
VR3446VR Incident ReportWord   02/01/2023
VR3448Employment Supports for Brain Injury - Provider Information and AcknowledgementsWord   02/01/2023
VR3449Employment Supports for Brain Injury - Professional StaffWord   11/02/2020
VR3454Benefits Counseling Provider Staff Information FormWord   08/01/2022
VR3455Provider Staff Information FormWord   11/01/2023
VR3472Contracted Service Modification RequestWord   02/01/2023
VR3472Contracted Service Modification Request for Blind and Visually Impaired ServicesWord   02/01/2023
VR3472Contracted Service Modification Request for Job Placement, Job Skills Training, and Supported Employment ServicesWord   02/01/2023
VR3472Contracted Service Modification Request for Project SEARCH ServicesWord   02/01/2023
VR3472Contracted Service Modification Request for Vocational AssessmentsWord   02/01/2023
VR3472Contracted Service Modification Request for Work Experience ServicesWord   02/01/2023
VR3472Contracted Service Modification Request for Work Readiness ServicesWord   02/01/2023
VR3473Customer Orientation Checklist for VR Service ProvidersWord   02/01/2023
VR3490Temporary Waiver of CredentialsWord   06/01/2022
VR3494Mechanic's Evaluation - Used VehicleWord   11/01/2017
VR5000Referral for Provider ServicesWord   06/26/2023
VR5053Application Statement for OIB ProgramWord   12/20/2023
VR5053-SDeclaración de Solicitud para el Programa de OIBWord   12/20/2023
VR5056Application for Vocational Rehabilitation ServicesWord   09/18/2023
VR5056-SSolicitud para Servicios Vocacionales de RehabilitaciónWord   09/18/2023
VR5110Refusal to Participate in TWS-VRS WIOA Section 511 Required ActivitiesWord   10/01/2017
VR5110-SRehusar Participar en Actividades Requeridas de TWS-VRS WIOA Sección 511Word   10/01/2017
VR5111Guardian Cover LetterWord   11/01/2023
VR5111-SHoja de presentación del tutorWord   11/01/2023
VR5112Career Counseling DatasheetWord   10/01/2017
VR5112-SHoja de Datos de Asesoría para CarrerasWord   10/01/2017
VR5113Career Counseling and Information and Referral for Individuals – Subminimum WageWord   05/01/2024
VR5113-SOrientación profesional e información y remisión para individuos - Salario inferior al mínimoWord   05/01/2024
VR5115TWS-VRS Career Counseling WorkbookWord   05/08/2024
VR5115-STWC VRS Libro de Trabajo de Asesoría para CarrerasWord   05/08/2024
VR5118Section 511 Cover Sheet for Group ThreeWord   07/03/2018
VR5118-SFracción 511 Hoja de Presentación para Grupo TresWord   07/03/2018
VR5159Individualized Plan for Employment (IPE) AmendmentWord   09/18/2023
VR5159-SPlan Individualizado de Empleo (IPE) EnmendadoWord   09/18/2023
VR5163Individualized Plan for Employment (IPE)Word   09/18/2023
VR5163-SPlan de empleo individualizadoWord   09/18/2023