0 Device Reutilization: General Device reutilization includes: device exchange program serves as intermediary program does NOT serve as intermediary

11

Device Reutilization:Device Reutilization:GeneralGeneral

Device reutilization includes: Device reutilization includes:

device exchangedevice exchange

program serves as intermediaryprogram serves as intermediary

program does NOT serve as intermediary program does NOT serve as intermediary

device recycle/refurbishdevice recycle/refurbish

device repairdevice repair

open-ended device loansopen-ended device loans

22

Device Reutilization: Device Reutilization: ExchangeExchange

First 2 years of data collection.First 2 years of data collection.

If you have a device exchange in which you do not If you have a device exchange in which you do not serve as the intermediary, you may:serve as the intermediary, you may:

1)1) Choose not to collect and report data on your Choose not to collect and report data on your exchange activity; exchange activity;

2)2) Collect information from the current owner of the Collect information from the current owner of the device; device;

3)3) Collect information from the recipient of the Collect information from the recipient of the device; or device; or

4)4) Collect information from a combination of the Collect information from a combination of the recipient and current owner.recipient and current owner.

33


You must establish your method of data collection up You must establish your method of data collection up front. front.

You must use a consistent method. You must use a consistent method.

You can change methods from the first year of the pilot You can change methods from the first year of the pilot to the second. to the second.

You will indicate which method of data collection you You will indicate which method of data collection you are using. are using.

You will provide a narrative explanation of how you are You will provide a narrative explanation of how you are collecting data, any challenges experienced in using collecting data, any challenges experienced in using this method, and plans for overcoming those this method, and plans for overcoming those challenges. challenges.

44


You still are responsible for collecting all data.You still are responsible for collecting all data.

Report data only when you have attempted to obtain Report data only when you have attempted to obtain the performance measure data. the performance measure data.

Nonrespondents will not count in the performance Nonrespondents will not count in the performance measure. measure.

At the conclusion of the pilot, a threshold nonresponse At the conclusion of the pilot, a threshold nonresponse rate will be established.rate will be established.

55

1. Did your statewide AT program conduct device 1. Did your statewide AT program conduct device reutilization activities* during the reporting period? reutilization activities* during the reporting period?

2. Did you operate a device exchange program* in 2. Did you operate a device exchange program* in which you did not serve as the intermediary?which you did not serve as the intermediary?

Drop-down box: (1) yes; (2) noDrop-down box: (1) yes; (2) no

3. 3. (If “Yes” to Item 2)(If “Yes” to Item 2) Are you piloting a data Are you piloting a data collection method for this device exchange collection method for this device exchange program?*program?*

Drop-down box: (1) yes; (2) no, data on this activity are not Drop-down box: (1) yes; (2) no, data on this activity are not being reportedbeing reported

4. 4. (If “Yes” to Item 3)(If “Yes” to Item 3) Please identify your data Please identify your data collection method.collection method.

Drop-down box: (1) collecting data from seller only; (2) Drop-down box: (1) collecting data from seller only; (2) collecting data from buyer only; (3) collecting data from both collecting data from buyer only; (3) collecting data from both seller and buyerseller and buyer

Device ReutilizationDevice Reutilization

66

Insert table “number of reutilized devices” from pg 18Insert table “number of reutilized devices” from pg 18

Activity Number of Individuals

Device Exchange

Recycling/refurbishing/repair

Open-ended loans

Subtotal of recycling/refurbishment/repair and open-ended loans System- generated

Total of all device reutilization System- generated

77

Insert device exchange activities table from top of page Insert device exchange activities table from top of page 19 19

Type of AT Device

Are devices in this category

included in your listing?

Number

Total Estimated

Current Purchase Price

Total Amount for

Which Devices Were

Sold

Savings to Consumers

Speech communication Y/N System- generated

Vision Y/N System- generated

Hearing Y/N System- generated

Computers and related Y/N System- generated

Daily living Y/N System- generated

Learning, cognition, and developmental Y/N System- generated

Environmental adaptations Y/N System- generated

Mobility, seating and positioning Y/N System- generated

Vehicle modification and transportation Y/N System- generated

Recreation, sports, and leisure Y/N System- generated

Other (specify) System- generated

Total System- generated

System- generated

System- generated System- generated

88

Insert device recycling activities table from top of page 20 Insert device recycling activities table from top of page 20

Type of AT Device



Number Recycled/

Refurbished/Repaired

Total Estimated


Total Amount for

Which Devices Were

Sold














System- generated


99

Insert open-ended loan activities table from top of page 21Insert open-ended loan activities table from top of page 21

Type of AT Device



Number Loaned

Total Estimated


Cost to Consumer for

the Loan














System- generated


1010

Device ReutilizationDevice ReutilizationCoordination and CollaborationCoordination and Collaboration

AnecdoteAnecdote

Performance MeasurePerformance Measure

Customer SatisfactionCustomer Satisfaction

Notes (2)Notes (2)

General NotesGeneral Notes

Pilot Program NotesPilot Program Notes

1111

Device Loans:Device Loans:GeneralGeneral

By definition these are By definition these are short-termshort-term loans. {Open-ended loans. {Open-ended loans are reutilization}loans are reutilization}

Loans can be for:Loans can be for:

decisionmakingdecisionmaking

“ “filling in the gap”filling in the gap”

short-term accommodationshort-term accommodation

self-education by a consumer or intermediaryself-education by a consumer or intermediary

trainingtraining

Only loans for the purpose of decision-making should Only loans for the purpose of decision-making should be included in the performance measures.be included in the performance measures.

1212

Device Loans:Device Loans:Number of BorrowersNumber of Borrowers

Same introductory questions as previous sections.Same introductory questions as previous sections.

If your program considers a loan to an “intermediary” If your program considers a loan to an “intermediary” on behalf of five “end users” to be a single loan, count on behalf of five “end users” to be a single loan, count only the intermediary as the borrower. only the intermediary as the borrower.

If your program considers this to be five loans, count all If your program considers this to be five loans, count all five students as borrowers. [You must be able to get five students as borrowers. [You must be able to get this data!] this data!]

Performance measures must be consistent with above! Performance measures must be consistent with above!

If the same individual or entity borrows devices on If the same individual or entity borrows devices on more than one occasionmore than one occasion during the reporting period, during the reporting period, count count each occasioneach occasion as a separate loan. as a separate loan.

1313

Insert table from page 27Insert table from page 27

Type of Individual or Entity Number of Device Borrowers

Individuals with disabilities

Family members, guardians, and authorized representatives

Educational organizations

Employers and businesses

Providers of employment and/or training services

Health, allied health, and rehabilitation organizations

Others


1414

Device Loans:Device Loans:Number of LoansNumber of Loans

Number of short-term device loans made during the Number of short-term device loans made during the reporting period: (Numeric field) reporting period: (Numeric field)

If the same individual or entity borrows devices on more If the same individual or entity borrows devices on more than one occasionthan one occasion during the reporting period, count each during the reporting period, count each occasion as a separate loan. occasion as a separate loan.

IIf you extend the period of a short-term device loan,f you extend the period of a short-term device loan, count count that as a separate loan that as a separate loan onlyonly if: if:

the extension is for a the extension is for a different purposedifferent purpose than the original loan; than the original loan; or or

(2) the borrower is an “intermediary” borrowing on behalf of (2) the borrower is an “intermediary” borrowing on behalf of others and the intermediary is requesting an extension to others and the intermediary is requesting an extension to accommodate a second “end user.” accommodate a second “end user.”

Be consistent with rules for number of borrowers.Be consistent with rules for number of borrowers.

1515

Device Loans:Device Loans:LengthLength

D. Length of Short-Term Device LoansD. Length of Short-Term Device Loans

1. What is the usual length of a short-term device loan, 1. What is the usual length of a short-term device loan, as established by your statewide AT program’s as established by your statewide AT program’s policies? policies?

If your program does not have an established policy, If your program does not have an established policy, enter the enter the averageaverage length of short-term device loans.* length of short-term device loans.* Please report the length in calendar days. Please report the length in calendar days.

Usual length of short-term device loan,* in days: Usual length of short-term device loan,* in days: (Numeric field)(Numeric field)

1616

Insert “types of device loaned” table from top of page 28Insert “types of device loaned” table from top of page 28

Type of AT Device Are devices in this category included in your listing? Number Loaned

Speech communication Y/N

Vision Y/N

Hearing Y/N

Computers and related Y/N

Daily living Y/N

Learning, cognition, and developmental Y/N

Environmental adaptations Y/N

Mobility, seating and positioning Y/N

Vehicle modification and transportation Y/N

Recreation, sports, and leisure Y/N

Other (specify)


1717

Insert primary purpose of device loan table from middle of page 28.Insert primary purpose of device loan table from middle of page 28.

Primary Purpose of Short-Term Device Loan Number

A. Assist in decision making (device trial or evaluation)

B. Serve as loaner during device repair or while waiting for funding

C. Provide an accommodation on a short-term basis

D. Other


1818

Device LoansDevice LoansCoordination and CollaborationCoordination and Collaboration

AnecdoteAnecdote



NotesNotes

1919

Device Demonstrations: Device Demonstrations: GeneralGeneral

Device demonstrations enable an individual to make an Device demonstrations enable an individual to make an informed choice. informed choice.

They are not:They are not:

Training activities at which devices are Training activities at which devices are demonstrated.demonstrated.

Public awareness activities at which devices are Public awareness activities at which devices are demonstrated. demonstrated.

2020

Device Demonstrations: Device Demonstrations: GeneralGeneral

There are 2 types of device demonstrations:There are 2 types of device demonstrations:

1. Direct1. Direct

The consumer can physically interact with the The consumer can physically interact with the devicedevice

2. Indirect2. Indirect

The consumer does not interact with the device.The consumer does not interact with the device.

2121

Device Demonstrations:Device Demonstrations:Number of Number of

DemonstrationsDemonstrationsA. A. Number of Demonstration Sessions and Devices Number of Demonstration Sessions and Devices Demonstrated; Number of People Making a DecisionDemonstrated; Number of People Making a Decision

1. In the table below, enter 1. In the table below, enter

a. The total number of direct and indirect a. The total number of direct and indirect demonstration sessionsdemonstration sessions you conducted during you conducted during the reporting period [Column (a)]. the reporting period [Column (a)].

b. The total b. The total number of devices demonstratednumber of devices demonstrated [Column (b)]. [Column (b)].

c. The total c. The total number of decisionmakers (or for number of decisionmakers (or for individuals for whom a decision is being individuals for whom a decision is being made). made). This category includes consumers and This category includes consumers and individuals individuals representingrepresenting an agency or organization an agency or organization

2222

Insert table from bottom of page 33Insert table from bottom of page 33

Type of Demonstration

(a)Number of

Demonstration Sessions

(b)Number of

Devices Demonstrated

(c)Number of Individuals

Participating in Demonstration

(d)Number of People Who Are

Making A Decision (or for Whom a Decision is

Being Made)

Direct Y/N

Indirect Y/N


System- generated

System- generated

System- generated

2323

Device Demonstration:Device Demonstration:Types of Participants Types of Participants

C. Types of ParticipantsC. Types of Participants

1. In the table below, enter the number of individuals 1. In the table below, enter the number of individuals who participated in direct and indirect who participated in direct and indirect

demonstration sessions, demonstration sessions, by type of participantby type of participant. . Include all individuals participating in Include all individuals participating in demonstrations, not just those who are making a demonstrations, not just those who are making a decision (or for whom a decision is being made). decision (or for whom a decision is being made).

If an individual participated in more than one If an individual participated in more than one demonstration session, count him or her only once. demonstration session, count him or her only once.

2424

Insert table C.1 from page 34Insert table C.1 from page 34

Type of Participant Direct Demonstrations Indirect Demonstrations

Individuals with disabilities

Family members, guardians, and authorized representatives

Educational organizations

Employers and businesses

Providers of employment and/or training services

Health, allied health, and rehabilitation organizations

Others

Total System- generated System- generated

2525

Device Demonstrations:Device Demonstrations:ReferralsReferrals

For participants attempting to make a decision about an For participants attempting to make a decision about an AT device or service, enter the number of referrals AT device or service, enter the number of referrals made to each type of entity. Since an individual may made to each type of entity. Since an individual may receive more than one referral, the number of referrals receive more than one referral, the number of referrals may exceed the number of participants. Do not include may exceed the number of participants. Do not include referrals to other components of your statewide AT referrals to other components of your statewide AT program.program.

Do not include I&R referrals here.Do not include I&R referrals here.

Do not include referrals to your own program.Do not include referrals to your own program.

A referral includes: A referral includes: specificspecific information about where a information about where a customer may obtain additional information or services customer may obtain additional information or services related to AT and how to contact that source directly. related to AT and how to contact that source directly.

2626

Insert table C.2 from page 34 hereInsert table C.2 from page 34 here

Type of Entity Number of Referrals

Funding source (non-At program)

Service provider

Vendor

Repair service

Others System- generated

2727

Insert table from top of page 35 hereInsert table from top of page 35 here

Type of AT Device/Service Direct Demonstrations Indirect Demonstrations

Speech communication

Vision

Hearing

Computers and related

Daily living

Learning, cognition, and developmental

Environmental adaptations

Mobility, seating and positioning

Vehicle modification and transportation

Recreation, sports, and leisure

Other (specify)

Total System- generated System- generated

2828

Device DemonstrationsDevice DemonstrationsCoordination and CollaborationCoordination and Collaboration

AnecdoteAnecdote



NotesNotes

Documents

0 Device Reutilization: General Device reutilization includes: device exchange program serves as intermediary program does NOT serve as intermediary