ࡱ                >  	               '          )          &    #`	               /   bjbjmm                  	 8:                                                                           Z      Z  Z      Z      Z      Z      Z             n                    8   .  \     <   n        (        (                         7     +  |                                            >  h    \     9                   Z                                                                  Z      Z                              y      y      y        p   Z            Z                          y                                                                          y              y      Z      Z                                                              y                 H>h                p   y                     0         y                       y                                                                                            Z      y                 y                                                                                                                o  
                                                                                           n      n      n  d    $  n      n      n            n      n      n      Z      Z      Z      Z      Z      Z                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  E M B E D   P r e s e n t a t i o n s . D r a w i n g . 1 0         M i s s o u r i   D e p a r t m e n t   O f   S o c i a l   S e r v i c e s ,   F a m i l y   S u p p o r t   D i v i s i o n  O l d e r   B l i n d   G r a n t   D a t a   S h e e t      O B S   2   N a m e   ( L a s t ,   F i r s t ,   M I )     F O R M T E X T            C a s e l o a d   #     F O R M T E X T             C a s e   N u m b e r     F O R M T E X T            F e d e r a l   F i s c a l   Y e a r   ( 1 0 - 0 1 - X X   t h r u   9 - 3 0 - X X )     F O R M T E X T             S e r v i c e s   P r o v i d e d   T r a i n i n g     F O R M C H E C K B O X     1 )   O r i e n t a t i o n   A n d   M o b i l i t y     F O R M C H E C K B O X     2 )   C o m m u n i c a t i o n   S k i l l s     F O R M C H E C K B O X     3 )   D a i l y   L i v i n g   S k i l l s     F O R M C H E C K B O X     4 )   L o w   V i s i o n   T r a i n i n g   ( I n c l u des Magnification No Less Than 3.50) FORMCHECKBOX 5) Advocacy FORMCHECKBOX 6) Management Of Secondary DisabilitiesOther Individual Services FORMCHECKBOX 7) Counseling (Individual, Peer Support, Mentoring, Family)Note:  Please Check This Field On Every 26 Case Closure FORMCHECKBOX 8) Readers/Guides/Interpreters FORMCHECKBOX 9) Referral For VR Services FORMCHECKBOX 10) Referral To Other Agencies FORMCHECKBOX 11) Support Groups FORMCHECKBOX 12) Community Integration FORMCHECKBOX 13) Low Vision Screening FORMCHECKBOX 14) Low Vision Aids FORMCHECKBOX 15) Other Adaptive Aids/Equipment FORMCHECKBOX 16) Transportation FORMCHECKBOX 17) Visual Restoration FORMCHECKBOX 18) Other ServicesClosure FORMCHECKBOX Closed Status 26 = Successfully RehabilitatedDate Of Closure:  FORMTEXT                                                                                                                                                                                       D  F  H  J  L      	  	  	  "	  >	  B	  D	  F	  H	  Ǵݥݕzj[L[@- %j    hn\L h CJ$ OJ QJ UaJ$ hvF CJ$ OJ QJ aJ$  hn\L h CJ$ OJ QJ aJ$  hn\L hvF CJ$ OJ QJ aJ$  hn\L hvF 5CJ$ OJ QJ aJ$ h> h> OJ QJ  hvF h> 5CJ OJ QJ aJ hvF hX 5CJ OJ QJ aJ hvF hX CJ OJ QJ aJ  %j    hvF hvF CJ OJ QJ UaJ +jE
hvF h> CJ OJ QJ UVaJ hvF h> CJ OJ QJ aJ  %j    hvF h> CJ OJ QJ UaJ     L    	  	  F	  n	  	  	                                      l            f            f            ]            ]                                                          	  $If   gd   $If   ~  kd  $$If   +              0 1*\                 &                
t  0                              +                            4   4 
+ a  ytvF 	  $If   gdX   $$If   a$gdX     .  /                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               H	  \	  ^	  `	  j	  l	  n	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  
  
  D
  ȯ񟒟|ȯmWȯF  h h @CJ  OJ QJ aJ   +jv  hn\L h CJ$ OJ QJ UaJ$ hn\L hvF CJ$ OJ QJ aJ$  +jU  hn\L h CJ$ OJ QJ UaJ$ h 5CJ$ OJ QJ aJ$ hn\L h 5CJ$ OJ QJ aJ$ 0j    hn\L h CJ$ OJ QJ UaJ$ mH nH u %j    hn\L h CJ$ OJ QJ UaJ$ +jC  hn\L h CJ$ OJ QJ UaJ$ hn\L h CJ$ OJ QJ aJ$ 	  	  	  	  F
  n
              {            {            {            {                                                                                                                                                                           $If   ~  kd  $$If   +              0 !* 7!                 	                
t  0                              +                            4   4 
+ a  yt  D
  F
  H
  \
  ^
  `
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  l
  p
  
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         ͷܞ͎o\M7\M\M                +j\  hn\L h0Q^ CJ$ OJ QJ UaJ$ hn\L h0Q^ CJ$ OJ QJ aJ$  %j    hn\L h0Q^ CJ$ OJ QJ UaJ$ hn\L h0Q^ 5CJ$ OJ QJ aJ$ hn\L hn\L CJ$ OJ QJ aJ$  hn\L hn\L 5CJ$ OJ QJ aJ$ 0j    hn\L h CJ$ OJ QJ UaJ$ mH nH u +j"  hn\L h CJ$ OJ QJ UaJ$ hn\L h CJ$ OJ QJ aJ$  %j    hn\L h CJ$ OJ QJ UaJ$  hn\L h @CJ$ OJ QJ aJ$ n
  p
  
              x                                                                                                                                                                                                                      	  $If   gdvF ~  kd  $$If   +              0 *                              
t  0                              +                            4   4 
+ a  yt  
  
  
    T    %  B  {                                                                                                                                                                                                                                            	  $If   gdvF k  kd  $$If   +             {  *+                
t  0                              +                4   4 
+ a  yt     "  $  T  V  r  t  v              $  %  &  4  5  6  B  C  Q  R  S  z  {  |    ǱǛǊt^NN            hn\L h0Q^ 5CJ$ OJ QJ aJ$ +j  hn\L h0Q^ CJ$ OJ QJ UaJ$ +jf  hn\L h0Q^ CJ$ OJ QJ UaJ$  h h0Q^ @CJ$ OJ QJ aJ$  +j   hn\L h0Q^ CJ$ OJ QJ UaJ$ +j@  hn\L h0Q^ CJ$ OJ QJ UaJ$ hn\L h0Q^ CJ$ OJ QJ aJ$  %j    hn\L h0Q^ CJ$ OJ QJ UaJ$ +j|  hn\L h0Q^ CJ$ OJ QJ UaJ$  {  |        K  x        !  F  y                                          ~                                                                                                                                                $If   ^gdvF 	  $If   gdvF k  kd  $$If   +               * +              
t  0                              +                4   4 
+ a  ytvF                    *  +  ,  K  L  Z  [  \  x  y              ݷݡ݋ubS                                          hn\L h0Q^ CJ$ OJ QJ aJ$  %j    hn\L h0Q^ CJ$ OJ QJ UaJ$ +j9#  h h0Q^ CJ$ OJ QJ UaJ$ +je"  h h0Q^ CJ$ OJ QJ UaJ$ +j}!  h h0Q^ CJ$ OJ QJ UaJ$ h h0Q^ 5CJ$ OJ QJ aJ$ +je  h h0Q^ CJ$ OJ QJ UaJ$ h h0Q^ CJ$ OJ QJ aJ$  %j    h h0Q^ CJ$ OJ QJ UaJ$                            !  "  0  1  2  F  G  U  V  W  y  z              ǱǛǅoY                        +j'  hn\L h0Q^ CJ$ OJ QJ UaJ$ +j'  hn\L h0Q^ CJ$ OJ QJ UaJ$ +jU&  hn\L h0Q^ CJ$ OJ QJ UaJ$ +j%  hn\L h0Q^ CJ$ OJ QJ UaJ$ +j$  hn\L h0Q^ CJ$ OJ QJ UaJ$ hn\L h0Q^ CJ$ OJ QJ aJ$  %j    hn\L h0Q^ CJ$ OJ QJ UaJ$ +j$  hn\L h0Q^ CJ$ OJ QJ UaJ$                                  1  B  C  M  N      ,  Ǳǡǡǋ֡|gW?g=        U.j+  hvF hvF >*CJ$ OJ QJ UaJ$  hvF hvF >*CJ$ OJ QJ aJ$ (j    hvF hvF >*CJ$ OJ QJ UaJ$  hn\L hvF CJ$ OJ QJ aJ$  +j*  hn\L h0Q^ CJ$ OJ QJ UaJ$ hn\L h0Q^ 5CJ$ OJ QJ aJ$ +j])  hn\L h0Q^ CJ$ OJ QJ UaJ$ hn\L h0Q^ CJ$ OJ QJ aJ$  %j    hn\L h0Q^ CJ$ OJ QJ UaJ$ +j(  hn\L h0Q^ CJ$ OJ QJ UaJ$          1  P,  ,  X-  -  .                                                  ~                        ~                                                                                                                                     $If   ^gdvF k  kdc*  $$If   +               * +              
t  0                              +                4   4 
+ a  ytvF 	  $If   gdvF  	        ( I f   S e r v i c e   N e e d s   H a v e   B e e n   M e t )     F O R M C H E C K B O X     C l o s e d   S t a t u s   2 8   =   N o t   R e h a b i l i t a t e d    R e a s o n   F o r   C l o s u r e :      F O R M T E X T             D a t e   O f   C l o s u r e :      F O R M T E X T               F O R M C H E C K B O X     C l o s e d   S t a t u s   0 8   =   I n e l i g i b l e   D a t e   O f   C l o s u r e :    F O R M T E X T               F O R M C H E C K B O X     E l i g i b l e   B u t   N o t   C l o s e d   ( F o r   Y e a r   E n d   ( 9 - 3 0 )   R e p o r t i n g   O n l y )                M O   8 8 6 - 4 0 0 4   O B S - 2   L P   2 / 0 8                                                                                                                               P a g e      P A G E    1    o f      N U M P A G E S    1                                                                                       ,  
,  ,  ,  N,  P,  R,  n,  p,  r,  ,  ,  ,  ,  ,  ,  j]H8                                 hn\L h0Q^ >*CJ$ OJ QJ aJ$ (j    hn\L h0Q^ >*CJ$ OJ QJ UaJ$  hvF 5CJ$ OJ QJ aJ$ +j,  hn\L h0Q^ CJ$ OJ QJ UaJ$ hn\L h0Q^ CJ$ OJ QJ aJ$  %j    hn\L h0Q^ CJ$ OJ QJ UaJ$ hn\L h0Q^ 5CJ$ OJ QJ aJ$ hvF h0Q^ CJ  OJ QJ aJ   hn\L hvF CJ$ OJ QJ aJ$  (j    hvF hvF >*CJ$ OJ QJ UaJ$  3j    hvF hvF >*CJ$ OJ QJ UaJ$ mH nH u ,  ,   -  
-  -  -  0-  2-  F-  H-  J-  T-  V-  X-  Z-  v-  x-  z-  -  ӹӭӎvӹӞcMc=                            hn\L h0Q^ 5CJ$ OJ QJ aJ$ +jl/  hn\L h0Q^ CJ$ OJ QJ UaJ$ %j    hn\L h0Q^ CJ$ OJ QJ UaJ$ .j.  hn\L h0Q^ >*CJ$ OJ QJ UaJ$  hn\L h0Q^ >*CJ$ OJ QJ aJ$ hn\L h0Q^ CJ$ OJ QJ aJ$  hvF CJ$ OJ QJ aJ$  3j    hn\L h0Q^ >*CJ$ OJ QJ UaJ$ mH nH u(j    hn\L h0Q^ >*CJ$ OJ QJ UaJ$  .j-  hn\L h0Q^ >*CJ$ OJ QJ UaJ$ -  -  -  -  -  -  -  -  -  -   .  .  .   .  N.  P.  .  .  .  .  ξΌycySFS7           hvF h-q  CJ OJ QJ aJ  hvF 5CJ$ OJ QJ aJ$ hn\L h0Q^ 5CJ$ OJ QJ aJ$ +j&1  hn\L h0Q^ CJ$ OJ QJ UaJ$ %j    hn\L h0Q^ CJ$ OJ QJ UaJ$ 3j    hn\L h0Q^ >*CJ$ OJ QJ UaJ$ mH nH u.jN0  hn\L h0Q^ >*CJ$ OJ QJ UaJ$  hn\L h0Q^ >*CJ$ OJ QJ aJ$ (j    hn\L h0Q^ >*CJ$ OJ QJ UaJ$  hn\L h0Q^ CJ$ OJ QJ aJ$  h0Q^ 5CJ$ OJ QJ aJ$  .  .  .  .  .  .  .  .  .  .  .  /  /  /  /                                                                                                                                                                                                                        gdvF k  kd2  $$If   +               * +                
t  0                              +                4   4 
+ a  ytvF  .  .  .  .  .  .  .  .  .  p/  r/  ~/  /  /  /  /  /  /  /  /  /  /  /  /  /  ѯѤ                                                                                                                                                                      hvF h-q  CJ OJ QJ aJ  hoV=  hvF hoV= CJ aJ  !hoV= CJ OJ QJ aJ mH nH u!h( CJ OJ QJ aJ mH nH u%j    hvF hoV= CJ OJ QJ UaJ hvF hoV= CJ OJ QJ aJ  h  j    h U 6 &P 1h:pvF / =!"#h$ %                                                                                                                                                                                                                                                                                                                                                                                                                                                                               D d       
             6B80 /                                  0   
      
  #    A              b J  6Qwogz	 &     D       n  6Qwogz	PNG

   IHDR        3]F   gAMA  |Q   	pHYs  Y  Zrv  IDAThޭoIvǫ,L0`q:`8,	/PPf@;6X,IffH{=tX;^_^Ո̻`G0o>y$gٿ\~8U\l>(dwQyvw>Lncf]_GA왲X{zH7mM:sbz!1ϵmSI)M}lb"ʢ8X|Ѿc;A*Ve E/kQvLкH]3	1q\zCH/[f^XUXG1ND!0WsP@N*IxLƉQ4cnuhYAi`gt0G{s;LgA<.ӛfy5^=et#-2Ҭ$]xc
W~&5r)-LȻ($7&^Y@CLXr
@u
:1?n0<S(nN?c2(oL1=0W:6ʚ٦lN$/a?wmO+fM?,g1dvS<ϰ=;EXӹoT*,~-:mk5ugqѱm2bOPYˮ)?n!Q#c曛LOڇo6th)E>lIn - WжSQ[mBCRȋtnkpGOf[HuaOCݺ>nu	SbAy.bL?SΎj])5ptbX%yNǼmAY8Ój_;sCe{gu&7A<
VfFaq5.9ZEc/z>6JLjs9eX1j15"(, eb|NgTPTl­얁FeD(UƋ)ȭg	M^\5S2 fNb@җ_tLI+s`yiQ)YdZRBP*9RFxm\Od<yNψL0/)"$g0Ekzbh[@>S*_"0/I4:-İ\1=1x|5'̠DwZ4?cr`^22+<6wT6IR\L;IR[@S>g5g
(o`=mUD32%ILİ Dl
ܝU)f	d<cݞK9A1]EYi]j<	\f^4
-zIi.[D
ҤPnbvʙXI9&CZ	
*RA<F645LJ2V6Tab8QsiqZ8q"m Oz|U o;0<>)KmL">0*|u)\*xaJ1/E\ߕ1/ǈ]2Y:=EʛA;T9xZ%׆mA;i2ъqְ_k6yeMgyx<G	7}3bT2oSP	a'WTb:ݕeд4C>MGvsb5eɡٹx LUsb$y&Mʞ9C!VX005f s'NDYHf9]'Vr|)QX~JvL-pUE1Nl9<:CuRW}rugy*<7QĨ1_GЗzИlBe<ucK[?$3U?u{Y'ӠF0ckA9	;:ERM`W=0gW}I9٘fᯙFeV>_O~Mv3[A	f4\>FΌČyb̔dH\r)8Oϧ4{&g&y}&lmAcGH$E}*/-jxEzL(Kcn:.0NɭH80;<g#7[Htfx%Zf'jvw}0ܖgA׺S$8ZBz8^`T=Iȑa1矟'STP*x?Ȏ.O*ĘΉ􊗽RQda#GYk?bl<}Wi3)V{02-r|X{eE/~oy@=8߬ikϯrgL@{*Ec,XR(wD^fsLPT)&"Px'H=P+fWtL8by-RO+vFr#R]c/iƮ7Ŧ1Ue-T2.oRycTlau_4+y{
5 u6o[Xj|<g̵[m3SjʦΈm[XC)򵠪cFL=,\(rf<3(쩠}#dO)0jbw@we81`'/8?H(;>^KʒȨI8BT.gQ7dgOC%͐?64F/cP9m0Kn{\1+YSc-P0DL-R#([C3|N~3V"Gs&&Pȉ_mU7|JLsnu2<vn)P#21NaOA=(vĈI\ƥz-v08AD*Gߔ/vrUE1;۳W4}1\|^ DE]fzy$bZNYGʖ]J&ڔf11 Nk-Cѳm޶W=fBeXR|6ű}E9j짴]J[*RO%Y(b|>Vntc7JrjvdP<)%5"H%ubr91AI
-ieF۽J@fa*NxcTPyWߓA`8-v"uY64
sH:#:8/q#Ŗ|#Uzz`%J|_*=+gUY`ϩj~jl,˦ A;(hRt}3TJj5G&Y[#}^s2 xlaQ4{4Ybv%zsft+D7NN7X D|fiae>/Aa9veZ͗|lbAL2ĎE{ =Js5tHgCX)We-j1(g_1FY/ݺU-N"=}Ĕdcײ=?P(̝d(8댦 :yzYN`M9nZdqlD:d4F^ sb'|8A8/R2&`)9n3t5uKAGYb(ľ*O׎!\L:Z㈁r>{T|sH{D%&lKAW|PiKR%v7t\a=/'j)OQkGރQidZaȼ%ҨOw#/RӪ{HH]mU.\^U:X=T]5"WNxYM/gew؜8V                        	   
                                                                   !   "   #   $   %   A   (   @   T   ,   -   .   /   0   1   2   3   4   5   6   7   8   9   :   ;   <   =   >   ?   S   B   C   D   E   F   G   H   I   J   K   L   M   N   O   P   Q   R   U   W   X   Y   Z   [   \   ]   ^   _   `   a   b   c   d   R o o t   E n t r y                                                 	           F            pc]>h*          D a t a                                                         
                                        3      W o r d D o c u m e n t                                                                                     8:      O b j e c t P o o l                                                                        H>hpc]>h            _ 1 1 7 3 5 2 0 1 5 2                                               PRP '    H>hH>h             O l e                                                         
                                         7        W P G 2 0                                                                                                +   (       C o m p O b j                                                                                         }                	   
                                     '               F   ! 	   WP 7 [0]           
  PRP '   Corel Presentations 10 Drawing    Embed Source    Presentations.Drawing.10 9q                                                                                F     H                                                 F   H   d                                                                             Oh +'0                                                        	     WPC           (         -.    -. 5   1   3     9 X!      -.    b(   	  0                     	              C             (                                       F F 2~~00_~ <?X?9?ǎǏ|?!Ǐ <w     ?      >    >  6p0Q  8?!~<cx< uc8<?  u8 8| ?0 ??xp~?q ?  ? ?    ??            u?x       <      C??           ?   |?|<?> ?  À?   |?   ??0?  ? x  ??  0 ~  3     !  ` ? #| ?+   ? ?r  ? 	 a ?3  }~p?   ~#     8?! |u >?8    ?Ã ~    χǀ   p? ~?    Ç   ?Ç  ?     xA?C     88D  x   88`  > x  ?? ?  ?l? p >?ǀA0>??  ~ |   xp  x   Ç x     xp  8< A0> ?| ?`  > 0?`   03     L    ? ?  ??A |   >?8   ?p    `   ?1         <
 Ì 8?     |     x  0  @@ |? 8c  |` |?>`>?#`??6ó ?
? < pL?     ?? |        ?-?         ?8? x    4? 8    ? <8x?   &8<,@  >  <<$@O> 
| > ~  ?~ ?   ?<?<AO x?  N  ?     | ?      |? ?      ~s? ?      ~q 8 <     ~!u8    0 8  0? | x?<ar?? |~a? >?< ?r?  8   0     	`?   	`|  `  ?   >` `??   | `??   >?`??? ??
? g?? ??  |`Ã?  8`x? `? x<x? 08 ?~ |  c? x <   c?? p    C^? q H` 0? x 0? | 0<x?|π00????L@?? ` ?|??   ~X     Á    ? ?  qCxG3?<<G??  $8>s? <  ??< <0  ?|  | < @< ???<  ?p<?  x ?<?  >  8   ?   ?   C?   Ã ?~=      a ?  a ?u? ?0?? ?0q??  89?t ???>?x?V? ? ? ? ? ???  @ > ?? |   ?  a  ?   ??        ?          ?   ???   ?     ?  ? ? < V    ?  |?  x??   x?_? |??$  ?V?>?R? ? ? ?  8                      `   ?  ?? ?& ??|c < <?~|>     ??  u ?  s 8?? ?  ?    p Ç  >     ? ??up?u0Çp up ? >0 F 0? 0  >aa `Ï?`  ?a  p~ 0?q~  0~ ,?  ~   ???S ?  
  ?A0?v0?  ~ 3   &U3@tEV                                                                                                                                                                                                                                                                                                                O b j I n f o                                                      	                                                  B O l e P a r t                                                
                                                  W P G E x t e n t s                                                                                    
       1 T a b l e                                                                                                 V          8m%ֳ~kxUAɱ&`8_RPX2܍O@\3w|BnOm;4{{[K0ҝ}cO7Sdu-i}yLEtB7oGoES,^gFX>ê#§lN1a[Ōp˅/r=a_L3e>+h)|0||qӝ-6lTгM.1I4_s'/b_HM'`7N5J&Yg_N@i)	<1Vm[=SP.8N?îTzjWwRx!iWFk 8ĚUbRsV<&e
;KsmoA)(^zj9i[/#:42;n0Tty{IaCUPQ͖!?kZ!z,ޟgXw{E'=TE#ҎAЖtx)(nVw[CiwQrtn\!7WVLj!Cw)}6gfcKg0^p FϥSy5;2@Ԛޠ*ޑ<,?!YN=ğ^=V	xKJ~?P,U7W(O<]Ҷe*Qn71
#0S-ȵؿ=6ajco_!O6^\ng7'j6cemg	FQo>jmtkO7tQ0j;vnk{)̨h?wY2,g}.Vûirz;L̽.6=+tzY.s|Zǟd|s313?\ w-    IENDB`s $$If     !v h5 \5&#v \#v&:V +  
t  +  , 5 \5&4 
+ ytvF   D                                                                    T e x t 1           % O   B   S   C l i e n t   N a m e    
 l a s t   f i r s t   m i d d l e   * C l i e n t   n a m e ,   l a s t ,   f i r s t ,   m i d d l e   i n i t i a l                  D                                                                    T e x t 3            C a s e   l o a d   n u m b e r    C A S E L O A D   N U M B E R           m $$If     !v h5 7!5	#v 7!#v	:V +  
t  +  5 7!5	4 
+ yt    D                                                                    T e x t 2            O   B   S   C a s e   N u m b e r    C A S E   N U M B E R           ^  D                                                                    T e x t 4           < F e d e r a l   F i s c a l   Y e a r  
 E x a m p l e  
 1 0 / 1 / Y E A R  
 t h r o u g h    
 9 / 3 0 / Y E A R   9 F E D E R A L   F I S C A L   Y E A R     E X A M P L E     1 0 / 1 / Y E A R   T H R O U G H   9 / 3 0 / Y E A R           { $$If     !v h5 5#v #v:V +  
t  +  5 5/      4 
+ yt ] $$If     !v h5 +#v +:V + { 
t  +  , 5 +4 
+ yt    D                                                                   C h e c k 1         + S e r v i c e s   P r o v i d e d  
 O r i e n t a t i o n   a n d   m o b i l i t y   + S E R V I C E S   P R O V I D E D     O R I E N T A T I O N   A N D   M O B I L I T Y              D                                                                   C h e c k 2          C o m m u n i c a t i o n   S k i l l s    C O M M U N I C A T I O N   S K I L L S              D                                                                   C h e c k 3          D a i l y   l i v i n g   s k i l l s    D A I L Y   L I V I N G   S K I L L S           f  D                                                                   C h e c k 4         < L o w   v i s i o n   t r a i n i n g   i n c l u d e s   m a g n i f i c a t i o n   n o   l e s s   t h a n   3 . 5 0   = L O W   V I S I O N   T R A I N I N G     I N C L U D E S   M A G N I F I C A T I O N   N O   L E S S   T H A N   3 . 5 0              D                                                                   C h e c k 5          A d v o c a c y    A D V O C A C Y             D                                                                   C h e c k 6         $ M a n a g e m e n t   o f   s e c o n d a r y   d i s a b i l i t i e s   $ M A N A G E M E N T   O F   S E C O N D A R Y   D I S A B I L I T I E S           e $$If     !v h5 +#v +:V +  
t  +  5 +/      4 
+ ytvF   D                                                                   C h e c k 7         k C o u n s e l i n g ,   i n d i v i d u a l ,   p e e r   s u p p o r t ,   m e n t o r i n g ,   f a m i l y .     P l e a s e   c h e c k   t h i s   f i e l d   o n   e v e r y   2 6   c a s e   c l o s u r e .   g C O U N S E L I N G   I N D I V I D U A L ,   P E E R   S U P P O R T ,   M E N T O R I N G ,   F A M I L Y .     C H E C K   T H I S   B O X   F O R   A L L   S T A T U S   2 6   C A S E   C L O S U R E S              D                                                                   C h e c k 8          R e a d e r s ,   g u i d e s ,   i n t e r p r e t e r s    R E A D E R S ,   G U I D E S ,   I N T E R P R E T E R S              D                                                                   C h e c k 9          R e f e r r a l   f o r   V R   s e r v i c e s    R E F E R R A L   F O R   V R   S E R V I C E S              D                                                                   C h e c k 1 0          R e f e r r a l   t o   o t h e r   a g e n c i e s    R E F E R R A L   T O   O T H E R   A G E N C I E S              D                                                                   C h e c k 1 1          S u p p o r t   g r o u p s    S U P P O R T   G R O U P S              D                                                                   C h e c k 1 2          C o m m u n i t y   i n t e g r a t i o n    C O M M U N I T Y   I N T E G R A T I O N              D                                                                   C h e c k 1 3          L o w   v i s i o n   s c r e e n i n g    L O W   V I S I O N   S C R E E N I N G              D                                                                   C h e c k 1 4          L o w   v i s i o n   a i d s    L O W   V I S I O N   A I D S              D                                                                   C h e c k 1 5          O t h e r   a d a p t i v e   a i d s   e q u i p m e n t    O T H E R   A D A P T I V E   A I D S / E Q U I P M E N T              D                                                                   C h e c k 1 6          T r a n s p o r t a t i o n    T R A N S P O R T A T I O N              D                                                                   C h e c k 1 7          V i s u a l   r e s t o r a t i o n    V I S U A L   R E S T O R A T I O N             D                                                                   C h e c k 1 8         $ O t h e r   s e r v i c e s   n o t   p r e v i o u s l y   l i s t e d   $ O T H E R   S E R V I C E S   N O T   P R E V I O U S L Y   L I S T E D           e $$If     !v h5 +#v +:V +  
t  +  5 +/      4 
+ ytvF   D                                                                    C h e c k 1 9         K C l o s e d   s t a t u s   2 6   s u c c e s s f u l l y   r e h a b i l i t a t e d  
 i f   s e r v i c e   n e e d s   h a v e   b e e n   m e t                  D                                                                    T e x t 5            D a t e   o f   s t a t u s   2 6   c l o s u r e    D A T E   O F   S T A T U S   2 6   C L O S U R E             D                                                                   C h e c k 2 0         $ C l o s e d   s t a t u s   2 8   n o t   r e h a b i l i t a t e d  
   " C L O S E D   S T A T U S   2 8   N O T   R E H A B I L I T A T E D              D                                                                    T e x t 6            R e a s o n   f o r   s t a t u s   2 8   c l o s u r e    R E A S O N   F O R   S T A T U S   2 8   C L O S U R E              D                                                                    T e x t 7            D a t e   o f   s t a t u s   2 8   c l o s u r e    D A T E   O F   S T A T U S   2 8   C L O S U R E              D                                                                   C h e c k 2 1          C l o s e d   s t a t u s   0 8   i n e l i g i b l e    C L O S E D   S T A T U S   0 8   I N E L I G I B L E              D                                                                    T e x t 8            D a t e   o f   s t a t u s   0 8   c l o s u r e    D A T E   O F   S T A T U S   0 8   C L O S U R E             D                                                                   C h e c k 2 2         D E l i g i b l e   b u t   n o t   c l o s e d   u s e   f o r   y e a r   e n d   S e p t e m b e r   3 0   r e p o r t i n g   o n l y   E E L I G I B L E   B U T   N O T   C L O S E D .   U S E   F O R   Y E A R   E N D   S E P T E M B E R   3 0   R E P O R T I N G   O N L Y           W $$If     !v h5 +#v +:V +  
t  +  5 +4 
+ ytvF                                                                                                                                                                                                                                                           S u m m a r y I n f o r m a t i o n                           (                                                     D o c u m e n t S u m m a r y I n f o r m a t i o n           8                                        <       C o m p O b j                                                                                          q                                                                                                                                
   <     H     T     `     l     t     |                                      Stacey L. Schulte                             Normal.dot        SCHUMAN       4         Microsoft Office Word   @       @    /;h@    .3h@    <N<h                                                  ՜. +,0           h      p                                                                       (   Missouri Department of Social Services                      '                                                  Title            
  	           F   Microsoft Office Word Document 
   MSWordDoc    Word.Document.8 9q                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          L  @ L          N o r m a l      $ CJ OJ QJ ^J _HaJ mH	sH	tH	                  D A@ D          D e f a u l t   P a r a g r a p h   F o n t     R i@ R          T a b l e   N o r m a l      4 
l 4   a      ( k  (           N o   L i s t          : %@  :   =    E n v e l o p e   R e t u r n       d $@ d   rT    E n v e l o p e   A d d r e s s   !  @&+D/ ^@  CJ  aJ  j @ j   >   
 T a b l e   G r i d   7 :V 0                                   4 @ "4   n\L    H e a d e r      !   4  @ 24   n\L    F o o t e r      !   . )@ A.   n\L    P a g e   N u m b e r         '    :        &   f                              #  7  8  J  K  T        %  B  {  |        K  x        !  F  y            1  w      N                        $  %  (  @   0                 @   0                  @   0                  @   0                  @   0                  @   0                  @   0                 @   0                 @   0                  @   0                  @   0                  @   0                 @   0                  @   0                  @   0                  @   0                  @   0                  @   0                  @   0                  @   0                  @   0                  @   0                  @   0                  @   0                  @   0                  @   0                  @   0                  @   0                  @   0                  @   0                  @   0                  @   0                  @   0                  @   0                  @   0                  @   0                  @   0                  @   0                  @   0                  @   0                  @   0                  @   0                 @   0                  @   0                  @   0                  @   0                  @   0                   @ 08               @   0                   0 0                   @   0                   0 0                   @   0                    0 0                   @   0                    0 0                   @   0                   @   0               0Z 0 0                 (    &         x  y        (   0 0                   0 0                0 0                 d  00                   00               Z 00         
          00         	          00         	      \Z 0 0                              	                                 H	  D
            ,  ,  -  .  /                                      	  n
  
  {    .  /  	                        /  
       "   $                              #  /  5  T  d              %  5  B  R        +  K  [  x                !  1  F  V  y                B  N  T  w                    :  F  L  N  ^  '  :FFFFG$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$FG$FFG$FG$i   p   r   w            !  8                         @                           0    (    	                    
          B    
        S              	   ?              T e x t 1  T e x t 3  T e x t 2  T e x t 4  C h e c k 1  C h e c k 2  C h e c k 3  C h e c k 4  C h e c k 5  C h e c k 6  C h e c k 7  C h e c k 8  C h e c k 9  C h e c k 1 0  C h e c k 1 1  C h e c k 1 2  C h e c k 1 3  C h e c k 1 4  C h e c k 1 5  C h e c k 1 6  C h e c k 1 7  C h e c k 1 8  C h e c k 1 9  T e x t 5  C h e c k 2 0  T e x t 6  T e x t 7  C h e c k 2 1  T e x t 8  C h e c k 2 2          #  T        %  B      K  x        !  F  y        B  w        :  N  (                              	   
                                                                     6  e        6  S    ,  \          2  W          U          M  _  (                                    #  %  (                                                      #  %  (                                                            
    7  8  A  A                                    #  $  (                                            (                      -q  ]   e rT o. oV= n\L @2Z bB[ 0Q^ vKd "[l   K  n# X l =  vF 6k f ] ( >     &                     7  8  J  K  {  |          (                                 @4             O  '  P      P  
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