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North Carolina Division of Services for the Blind

NC DSB - Division of Services for the Blind Home Page

Vocational Rehabilitation Business Professional Services

If you are a VR professional or an interested business partner, look here for some general information and quick links to forms and documents that might assist you

On the Job Training  
Standard OJT Agreement required

Form located at:
http://info.dhhs.state.nc.us/olm/forms/dsb/dsb-4009-VR-ia.pdf

Time negotiable (3-month maximum).  Wage negotiable (at least minimum wage).  At least monthly progress reporting.  Wage reimbursed to employer.  Employer can "bill" on same monthly progress report.  Reporting form at:
http://info.dhhs.state.nc.us/olm/forms/dsb/dsb-4009-PR-VR-ia.pdf

 

MODIFIED OJT (Youth)
Modified OJT Agreement required

Form located at: 
http://info.dhhs.state.nc.us/olm/forms/dsb/dsb-4009-M-VR-ia.pdf

NCDOL Youth Employment Certificate required for all workers less than 18 years of age.  Form located at: www.nclabor.com/wh/yec.pdf

Time negotiable (3-month maximum).  Wage negotiable (at least minimum wage).  At least monthly progress reporting (suggest more frequent).  Wage reimbursed to employer.   Employer can "bill" on same monthly progress report. 

Reporting form at:
http://info.dhhs.state.nc.us/olm/forms/dsb/dsb-4009-PR-VR-ia.pdf

(VR STAFF: CASE CANNOT BE MOVED TO STATUS 22 WHILE CANDIDATE IS IN TRAINING)

 

WORK EXPERIENCE  (UNPAID) 
Agreement for Work Experience and Worker's Compensation Forms required

Work Experience Form located at: 
http://info.dhhs.state.nc.us/olm/forms/dsb/dsb-4009-WOP-VR-ia.pdf

    Exploration (</= 5 hours)

    Assessment (</= 90 hours)

    Adjustment (</= 120 hours)                                                         

Request for Workers’ Comp Coverage Form located at: 
http://info.dhhs.state.nc.us/olm/forms/dsb/dsb-4009-WCC-A-VR-ia.pdf

Stipend paid from case service funds, $10/$20 (Auth Code G09).

 

WORK EXPERIENCE FOR PLACEMENT
Agreement for Work Experience and Worker's Compensation Froms required

Work Experience Form located at: (see Work Experience, above)

Request for Workers’ Comp Coverage (see above)

Placement (use "Assessment") (< 40 hours) 

Stipend Paid, $10/$20, (Auth Code G09)

ALL WORK EXPERIENCE SERVICES SHOULD BE INDICATED ON THE IPE OR IEP AND COPIES OF ALL RECORDS TO THE CASE FILE.       

 

All DSB forms at: 

http://info.dhhs.state.nc.us/olm/forms/forms.aspx?dc=dsb

Most all DSB forms can be completed online, saved or printed.

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Division of Services for the Blind
Last modified:  July 17, 2008