RSA State Users
State of Arizona VRS MSP Program
About the Program
The State of Arizona Division of Employment and Rehabilitation Services (DERS), Rehabilitation Services Administration (RSA) has selected Knowledge Services as its Managed Service Provider (MSP) for Vocational Rehab (VR) under contract CTR075483. Knowledge Services MSP will specifically partner with RSA for Work Adjustment Training (WAT), Trial Work Experience (TWE), Job Training (JT), Vocational Assessment (VA), Comprehensive Neurorehabilitation Services (Comp Neuro), Rehabilitation Instructional Services (RIS), Job Development and Retention (JDR), Dental Services, Psychological Services (Psych), Vision Services, Audiology Services, Career Exploration, Supported Education, Rehabilitation Instructional Services (RIS) Blind and Visually Impaired (BVI), and Independent Living Older Blind Rehabilitation Instructional Services for Blind and Visually Impaired (ILOB RIS BVI).
Under this contract, the Knowledge Services MSP Program for Vocational Rehab Services will be referred to as AZVRS.
Program Documents
With the roll-out of the new MSP Program, RSA has updated the supporting documentation for Work Adjustment Training (WAT), Trial Work Experience (TWE), Job Training (JT), Vocational Assessment (VA), Comprehensive Neurorehabilitation Services (Comp Neuro), Rehabilitation Instructional Services (RIS), Job Development and Retention (JDR), Dental Services, Psychological Services (Psych), Audiology Services, Vision Services, Career Exploration, Supported Education, Tutoring Services, Rehabilitation Instructional Services for Blind and Visually Impaired (VR RIS BVI) and Independent Living Older Blind Rehabilitation Instructional Services for Blind and Visually Impaired (ILOB RIS BVI). These forms will be completed by the Vendor and submitted for your review for each authorization.
| VRS Program Documents | |
|---|---|
| Exhibit C4 - Job Placement Report | Download |
| Exhibit D – WAT Service Specifications | Download |
| Exhibit D1 – WAT Skills Appraisal Guide | Download |
| Exhibit D2 – WAT Client Service Plan | Download |
| Sample WAT Client Service Plan | Download |
| Exhibit D3 – WAT Monthly Progress Report | Download |
| Sample WAT Monthly Progress Report | Download |
| Exhibit D4 – WAT Service Closure Report | Download |
| Sample WAT Service Closure Report | Download |
| Exhibit D5 – WAT Affirmation of Qualifications | Download |
| Approved WAT Vendors | Download |
| Exhibit E - TWE Service Specifications | Download |
| Exhibit E1 - TWE Client Service Plan | Download |
| Sample TWE Client Service Plan | Download |
| Exhibit E2 - TWE Assessment Report | Download |
| Sample TWE Assessment Report | Download |
| Exhibit E3 - TWE Affirmation of Qualifications | Download |
| Approved TWE Vendors | Download |
| Exhibit F - JT Service Specifications | Download |
| Exhibit F1 - JT Client Service Plan | Download |
| Exhibit F2 - JT Monthly Progress Report | Download |
| Exhibit F3 - JT Service Closure Report | Download |
| Exhibit F4 - JT Affirmation of Qualifications | Download |
| Approved JT Vendors | Download |
| Exhibit G - VA Service Specifications | Download |
| Exhibit G1 - VA Evaluation Report | Download |
| Exhibit G2 - VA Post-Service Consultation Report | Download |
| Exhibit G3 - VA Affirmation of Qualifications | Download |
| Approved VA Vendors | Download |
| Exhibit J - Comp Neuro Service Specifications | Download |
| Exhibit J1 - Comp Neuro Assessment Report | Download |
| Exhibit J2 - Comp Neuro Monthly Progress Report | Download |
| Exhibit J3 - Comp Neuro Service Closure Report | Download |
| Exhibit J4 - Comp Neuro Affirmation of Qualifications | Download |
| Approved Comp Neuro Vendors | Download |
| Exhibit K - RIS Service Specifications | Download |
| Exhibit K1 - RIS Client Service Plan | Download |
| Sample RIS Client Service Plan | Download |
| Exhibit K2 - RIS Monthly Progress Report | Download |
| Sample RIS Monthly Progress Report | Download |
| Exhibit K3 - RIS Service Closure Report | Download |
| Sample RIS Service Closure Report | Download |
| Exhibit K4 - RIS Affirmation of Qualifications | Download |
| Approved RIS Vendors | Download |
| Exhibit L - JDR Service Specifications | Download |
| Exhibit L1 - JDR Client Service Plan | Download |
| Sample JDR Client Service Plan | Download |
| Exhibit L2 - JDR Monthly Progress Report | Download |
| Sample JDR Monthly Progress Report | Download |
| Exhibit L3 - JDR Service Closure Report | Download |
| Sample JDR Service Closure Report | Download |
| Exhibit L4 - JDR Affirmation of Qualifications | Download |
| Sample Job Placement Report | Download |
| Approved JDR Vendors | Download |
| Exhibit M – Dental Services Service Specification | Download |
| Exhibit M1 - Dental Services RSA Fee Schedule | Download |
| Exhibit M2 – Dental Services Approval Request Form | Download |
| Exhibit M3 – Dental Services Treatment Report | Download |
| Exhibit M4 – Dental Services Affirmation of Qualifications | Download |
| Approved Dental Vendors | Download |
| Exhibit N - Psych Services Service Specifications | Download |
| Exhibit N1 - Psych Services Evaluation Report | Download |
| Exhibit N2 - Psych Services Post-Assessment Consultation Report | Download |
| Exhibit N3 - Psych Services Client Service Plan | Download |
| Exhibit N4 - Psych Services Monthly Progress Report | Download |
| Exhibit N5 - Psych Services Client Records Review Report | Download |
| Exhibit N6 - Psych Services Affirmation of Qualifications | Download |
| Approved Psych Vendors | Download |
| Exhibit O - Audiology Services Service Specifications | Download |
| Exhibit O1 - Audiology Services Audiology Evaluation Report | Download |
| Exhibit O2 - Audiology Services Hearing Aid Recommendation Report | Download |
| Exhibit O3 - Audiology Services Hearing Aid Fitting and Follow-Up Report | Download |
| Exhibit O4 - Audiology Services Audiology Mobile Rate | Download |
| Exhibit O5 - Audiology Services Affirmation of Qualifications | Download |
| Exhibit P - Vision Services Service Specifications | Download |
| Exhibit P1 - Vision Services RSA Fee Schedule | Download |
| Exhibit P2 - Visions Services Basic Eye Evaluation Approval Request Form | Download |
| Exhibit P3 - Vision Services Basic Eye Evaluation Final Report | Download |
| Exhibit P4 - Vision Services Comprehensive Eye Evaluation Approval Request Form | Download |
| Exhibit P5 - Vision Services Comprehensive Eye Evaluation Final Report | Download |
| Exhibit P6 - Vision Services Comprehensive Clinical Low Vision Evaluation Approval Request Form | Download |
| Exhibit P7 - Vision Service Comprehensive Clinical Low Vision Evaluation Final Report | Download |
| Exhibit P8 - Vision Services Affirmation of Qualifications | Download |
| Approved Vision Vendors | Download |
| Exhibit Q - Career Exploration Service Specifications | Download |
| Exhibit Q1 - Career Exploration Client Service Plan | Download |
| Sample Career Exploration Client Service Plan | Download |
| Exhibit Q2 - Career Exploration Monthly Progress Report | Download |
| Sample Career Exploration Monthly Progress Report | Download |
| Exhibit Q3 - Career Exploration - Career Exploration Summary | Download |
| Sample Career Exploration - Career Exploration Summary | Download |
| Exhibit Q3a - Career Exploration Labor Market Survey | Download |
| Sample Career Exploration Labor Market Survey | Download |
| Exhibit Q3b - Career Exploration Informational Interviewing | Download |
| Sample Career Exploration Informational Interviewing | Download |
| Exhibit Q4 - Career Exploration Service Closure Report | Download |
| Sample Career Exploration Service Closure Report | Download |
| Exhibit Q5 - Career Exploration Affirmation of Qualifications | Download |
| Approved Career Exploration Vendors | Download |
| Exhibit R - Supported Education Service Specifications | Download |
| Exhibit R1 - Supported Education Client Service Plan | Download |
| Sample Supported Education Client Service Plan | Download |
| Exhibit R2 - Supported Education Monthly Progress Report | Download |
| Sample Supported Education Monthly Progress Report | Download |
| Exhibit R3 - Supported Education – Supported Education Checklist | Download |
| Sample Supported Education – Supported Education Checklist | Download |
| Exhibit R4 - Supported Education Service Closure Report | Download |
| Sample Supported Education Service Closure Report | Download |
| Exhibit R5 - Supported Education Affirmation of Qualifications | Download |
| Approved Supported Ed Vendors | Download |
| Exhibit U - Tutoring Services Service Specifications | Download |
| Exhibit U1 - Tutoring Services Client Service Plan | Download |
| Sample Tutoring Services Client Service Plan | Download |
| Exhibit U2 - Tutoring Services Monthly Progress Report | Download |
| Sample Tutoring Services Monthly Progress Report | Download |
| Exhibit U3 - Tutoring Services Service Closure Report | Download |
| Sample Tutoring Services Service Closure Report | Download |
| Exhibit U4 - Tutoring Services Affirmation of Qualifications | Download |
| Approved Tutoring Vendors | Download |
| Exhibit V - ILOB Rehabilitation Services for Blind and Visually Impaired Service Specifications | Download |
| Exhibit V1 - ILOB Rehabilitation Services for Blind and Visually Impaired Client Service Plan | Download |
| Sample ILOB Rehabilitation Services for Blind and Visually Impaired Client Service Plan | Download |
| Exhibit V2 - ILOB Rehabilitation Services for Blind and Visually Impaired Evaluation Report | Download |
| Sample ILOB Rehabilitation Services for Blind and Visually Impaired Evaluation Report | Download |
| Exhibit V3 - ILOB Rehabilitation Services for Blind and Visually Impaired Monthly Progress Report | Download |
| Sample ILOB Rehabilitation Services for Blind and Visually Impaired Monthly Progress Report | Download |
| Exhibit V4 - ILOB Rehabilitation Services for Blind and Visually Impaired Service Closure Report | Download |
| Sample ILOB Rehabilitation Services for Blind and Visually Impaired Service Closure Report | Download |
| Approved ILOB RIS BVI Vendors | Download |
| Exhibit W - Rehabilitation Services for Blind and Visually Impaired Service Specifications | Download |
| Exhibit W1 - Rehabilitation Services for Blind and Visually Impaired Client Service Plan | Download |
| Sample Rehabilitation Services for Blind and Visually Impaired Client Service Plan | Download |
| Exhibit W2 - Rehabilitation Services for Blind and Visually Impaired Evaluation Report | Download |
| Sample Rehabilitation Services for Blind and Visually Impaired Evaluation Report | Download |
| Exhibit W3 - Rehabilitation Services for Blind and Visually Impaired Monthly Progress Report | Download |
| Sample Rehabilitation Services for Blind and Visually Impaired Monthly Progress Report | Download |
| Exhibit W4 - Rehabilitation Services for Blind and Visually Impaired Service Closure Report | Download |
| Sample Rehabilitation Services for Blind and Visually Impaired Service Closure Report | Download |
| Approved VR RIS BVI Vendors | Download |
| Effective 4/1/2026: Exhibit Z - Comp BVI Service Specifications | Download |
Program Links
Questions?
Please email the Knowledge Services AZVRS Program Team and they will be happy to assist you.