Tip for State-specific (e.g., WA DSHS 11-022)

DVR services are free and may include job training, education, job placement, assistive technology, and supported employment

Tip for State-specific (e.g., WA DSHS 11-022)

If you receive SSI or SSDI, you are generally presumed eligible for DVR services

Tip for State-specific (e.g., WA DSHS 11-022)

DVR can also help with accommodations, resume building, interview skills, and workplace supports

Rehabilitationmoderate

Vocational Rehabilitation Application

State-specific (e.g., WA DSHS 11-022) · State Divisions of Vocational Rehabilitation

Application for VR services to help people with disabilities prepare for, find, and keep jobs. Eligibility based on disability that creates a barrier to employment.

Form Details

Total fields: 45
Auto-fillable: 28 (62%)
Time without BeneFill: 40 minutes
Time with BeneFill: 10 minutes
Time saved: 30 minutes
Filled by: patient
Frequency: one time
State-specific: Yes — form may vary by state

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Where to Submit This Form

🌐

Apply through your state's Division of Vocational Rehabilitation (DVR) website

Each state has its own DVR agency — search for '[your state] vocational rehabilitation' to find the website.

🏢

Visit your local DVR office

Find your local office through your state's DVR website or call 211 for a referral.

🌐

Call your state DVR office to start the application process

Each state has its own intake process.

Filing Deadline

No specific deadline — you can apply at any time. Services are provided on an order of selection basis if the state has a waitlist.

Required Attachments

📎 Completed DVR application form (state-specific)
📎 Medical documentation of disability
📎 Employment history and vocational goals
📎 Any previous vocational assessments or evaluations
📎 Social Security disability award letter (if applicable)
📎 School records and IEP/504 documentation (for transition-age youth)

Processing Time

Eligibility determination: within 60 days of application. If eligible, an Individualized Plan for Employment (IPE) is developed within 90 days.

What Happens Next

A DVR counselor will be assigned and will meet with you to discuss your employment goals, assess your needs, and determine eligibility. If eligible, you will work together to develop an Individualized Plan for Employment (IPE).

Tips for This Form

✓ DVR services are free and may include job training, education, job placement, assistive technology, and supported employment
✓ If you receive SSI or SSDI, you are generally presumed eligible for DVR services
✓ DVR can also help with accommodations, resume building, interview skills, and workplace supports
✓ Transition-age youth (14-24) should apply to DVR while still in high school for a seamless transition

More Rehabilitation Forms

IRF-PAI (Inpatient Rehabilitation Facility Patient Assessment)

IRF-PAI · CMS

Assessment instrument determining Medicare Part A FFS payment for IRF stays. Must be in the patient's medical record, dated, timed, and authenticated.

Rehabilitation Unit Compliance Form

CMS-437A · CMS

Documents that a rehabilitation unit is fully equipped and staffed for hospital inpatient rehabilitation care.

Rehabilitation Hospital Criteria Worksheet

CMS-437B · CMS

Submitted to maintain IPPS-excluded status for inpatient rehabilitation facilities.

Inpatient Rehab Pre-Authorization

Insurer-specific · Health insurance plans / UM organizations

Pre-certification for inpatient rehab admission. Must document patient can participate in 3 hours of therapy, 5 days per week (15 hours per week).

Outpatient PT/OT/ST Prior Authorization

Insurer/state-specific · Health insurance plans / State Medicaid

Prior authorization for outpatient physical therapy, occupational therapy, or speech therapy. Must specify frequency, duration, and medical necessity.

Concurrent Therapy Treatment Request / Recertification

Insurer-specific · Health insurance plans

Request for continued therapy beyond initial authorization period. Must document progress toward goals and continued medical necessity.

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the State Divisions of Vocational Rehabilitation or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.