Washington State Department of Services for the Blind

The Initial Interview*

At least one face-to-face interview is required of applicants in order for the Department of Services for the Blind (DSB) to determine eligibility for the Vocational Rehabilitation (VR) program.

The interviewer’s role is to:

1. Explain the purpose of the VR program, eligibility criteria, and services available to the participant.
2. Complete the Application for Services if desired.
3. Explain the participant’s rights and responsibilities including:
   1. The right to participate in eligibility determination,
   2. The right to develop a plan personally, with external technical assistance or in collaboration with the counselor,
   3. The right to appeal any decision made by the VR program on his or her behalf and the methods of appeal that may be used.
4. Explain services offered by the Client Assistance Program (CAP).
5. Explain how personal information about the participant is protected, how it will be used, and conditions under which it can be released.
6. Explain DSB’s policy regarding information in alternative formats (large print, Braille, and cassette), and the availability of interpreter services for individuals who are deaf or deaf-blind.
7. Obtain information necessary to determine the applicant’s eligibility for VR services. Obtain a consent for release of information for each record requested.

The applicant’s role in the initial interview for VR services is to provide the following personal information:

1. Full legal name
2. Current residential and mailing address
3. Current telephone number
4. E-mail address, if applicable
5. Birthdate
6. Social Security Number
7. Name of referral agency (e.g. DVR, friend, self)
8. A brief description of your visual disability (e.g. “I have macular degeneration and am legally blind,” or “I have diabetic retinopathy and am visually impaired.”)
9. Type of alternative format you use (i.e. disk, Braille, large print, and/or cassette tape)
10. Race/Ethnicity (e.g. Caucasian, African American, Asian)
11. Highest education level attained (e.g. High School graduate, Post-secondary education but no degree)
12. Marital status
13. Current living arrangement (e.g. private residence, rehabilitation facility)
14. Current work/employment status (e.g. competitive employment, self-employment, student – not employed)
15. Weekly earnings and hours worked, if you are employed
16. Last date of employment, if you are not employed
17. Medical coverage (e.g. Medicaid, Medicare, private insurance)
18. Amount of primary and/or secondary public assistance received (e.g. SSI, SSDI, Veterans Disability Benefits)
19. Ophthalmologist contact information, including name, address, telephone number, and fax number
20. General medical doctor contact information, including name, address, telephone number, and fax number
21. Brief description of all primary and secondary impairments (e.g. hearing impairments, mobility impairments, cognitive impairments) and their causes (e.g. congenital, injury, diabetes, multiple sclerosis)
22. Previous work experience
23. Previous education

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