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Low Vision Expo Program Resources
Agencies and Programs:
American Council of the Blind (ACB)
Phone: 800‐424‐8666
Email: [email protected]
Website: www.acb.org
Pennsylvania Council of the Blind (PCB)
Phone: 800‐736‐1410
Email: [email protected]
Website: www.pcb1.org
Monroe County Council of the Blind (MCCB)
Phone: 570‐ 421‐ 4118
Website: www.mccbonline.org
Bureau of Blindness and Visual Services (BBVS)
Phone: 570‐ 823‐ 2361
Website: www.dli.state.pa.us/landi/cwp/view.asp?a=128&Q=190368
Visual Impairment and Blindness Services (VIABL)
Phone: 610‐ 866‐8049
Website: www.viableservices.org
Seniors Eye Care Program
Phone: 800‐222‐3937
Website: http://www.eyecareamerica.org
International Academy of Low Vision Specialists
Phone: 877‐ 577‐ 2040
Website: www.ialvs.com
Pennsylvania’s Initiative on Assistive Technology (PIAT)
Phone: 800‐204‐7428
Website: http://disabilities.temple.edu/programs/assistive/piat/#a
Device demonstration and loans
Educational:
National Library Service (NLS)
Phone: 800‐222‐1754
Website: http://www.loc.gov/nls
Recordings for the Blind and Dyslexic (RFBD)
Phone: 1‐800‐221‐4792
Website: www.rfbd.org
Low Vision, Independent Living Aids, Communication Aids, Lighting & More:
Cleveland Sight Center
Email: [email protected]
Website: http://eyedeashop.com/viewProducts.aspx?category=50 OR
http://eyedeashop.com/viewProducts.aspx?category=63
Maxi‐Aids Http://www.maxiaids.com/store/default.asp
Independent Living Aids www.independentliving.com/catalogrequest.asp
American Printing House for the Blind (APH) www.aph.org
Screen Readers, Software and Equipment:
Freedom Scientific
Phone: 800‐444‐4443
Website: www.freedomscientific.com
Humanware
Email: [email protected]
Phone: 888‐732‐7273
Website: www.humanware.com
Vision Technology
Phone: 800‐ 560‐ 7226
Website: http://www.visiontechnology.com
ZoomText www.alsquared.com
Enhanced Vision Systems (EVS)
Phone: 888‐811‐3161
Email: [email protected]
Website: http://www.enhancedvision.com
Lighthouse International
Phone: 800‐ 829‐ 0500
Website: www.lighthouse.org
Accessible Cell Phones & Aids:
Mobilspeak/MobilMagnifyer
Website: www.codefactory.es
AT&T National Center for Customers with Disabilities 866‐ 241‐ 6568
Website: www.wireless.att.com/about/disabilityresources/nccd.jsp
Jitterbug
Phone: 866‐ 932‐ 6986
Website: Http://www.jitterbug.com
An overview of accessible cell phone www.afb.org/AFBPress/pub.asp?DocID=aw060206
Miscellaneous:
GE Reveal Light Bulbs www.gelighting.com/na/reveal/com
Benefits Check Up www.benefitscheckup.org
Social Security www.socialsecurity.org
Self‐Help & Resource http://www.visionaware.org
1
Commonwealth of Pennsylvania’s Telecommunication Device Distribution Program APPLICATION FORM
It could be the answer to your telecommunication needs!
The Telecommunication Device Distribution Program (TDDP) established by Act 34-
1995 and amended by Act 181-2002 provides telecommunication devices to
qualified applicants. These devices enable eligible individuals with disabilities to
access telephone services independently. To be eligible, individuals must complete
this application and meet all criteria listed below.
TDDP is implemented by Pennsylvania’s Initiative on Assistive Technology (PIAT), a
program of the Institute on Disabilities at Temple University, in conjunction with the
PA Office of Vocational Rehabilitation (OVR) and the PA Public Utility Commission
(PUC).
CRITERIA
Person with a Disability
A person with a disability or disabilities that prevents him/her from making or receiving telephone calls
independently. A licensed physician, audiologist, speech pathologist or a representative of a qualified
State agency (e.g. Office of Vocational Rehabilitation Counselor, Department of Public Welfare or
Social Security Administration Case Worker) must certify the disability.
Income Limits
Applicant’s gross income of 200% (not including family/household income) of federal poverty level or
less. (see financial eligibility criteria)
Age
Six (6) years or older.
Residence
A resident of Pennsylvania.
Resources
Must have access to residential telephone service and possess the ability to learn how to use a
telecommunication device.
Information will be kept confidential
2
Except as required by law.
Equipment Ownership and Responsibility
Equipment will be delivered to your home. It then becomes YOUR PROPERTY and YOUR
responsibility.
NOTE: There is a Limited Manufacturer Defect Warranty on all equipment purchased under this program. If your equipment is defective or if it should fail, it will be your responsibility to contact the Manufacturer for warranty repair. Repairs for damages due to abuse or neglect are not covered under any warranty and are YOUR RESPONSIBILITY. Stolen equipment can only be replaced upon receipt of a copy of the police report of the theft.
Make a copy of your application for your records.
Return the completed ORIGINAL application (see mailing address on front page).
FINANCIAL ELIGIBILITY CRITERIA / 2009-10 GUIDELINES
Size of family unit Gross Income (200% of federal poverty level)
1 ____________________________________________ $21,660
2 ____________________________________________ $29,140
3 ____________________________________________ $36,620
4 ____________________________________________ $44,100
5 ____________________________________________ $51,580
6 ____________________________________________ $59,060
7 ____________________________________________ $66,540
8 ____________________________________________ $74,020
If you need help in completing this application, or need it in an alternate format,
please contact us.
Phone: 800-204-7428 voice / 866-268-0579 TTY
Fax: 215-204-9371 / Email: [email protected]
3
TDDP Application /TDDP Eligibility
Your eligibility will be determined when you have submitted a completed application and all
documentation. To avoid delay, please type or print clearly and make sure all sections of the
application have been completed. If questions do not pertain to you, write “N/A” on the line provided.
SECTION 1 APPLICANT EQUIPMENT NEED
1) Do you already own telecommunication equipment similar to what you are applying for?
YES
NO
If YES, please check the correct answer below:
My equipment
o is broken or only works sometimes
o is borrowed
o does not meet my needs
Important NOTE: If you have working equipment that meets your needs you will not be eligible for the program at this time.
SECTION 2 CERTIFICATION
Please note: This section must be completed by a licensed physician, audiologist, or speech-language pathologist acting within the scope of his/her license, OR representative of a qualified agency, such as an Office of Vocational Rehabilitation (OVR) Counselor, Department of Public Welfare (DPW) or Social Security Administration Case Worker. Make sure all lines are completed and appropriate spaces are marked before submitting this application.
1) Applicant being certified
Last name ____________________ First name _______________________ Middle initial _____
2) Check the type of disability being certified.
o cognitive
o deaf
o deaf blind
o hard of hearing
o low vision/blind
o physical
o speech
4
I am a:
o licensed audiologist
o licensed speech pathologist
o licensed physician
o representative of a qualified state agency
3) Certifying professional
Name ___________________________________ Title _________________________________
Agency_______________________________________________________________________
PA Professional License Number (if applicable) _______________________________________
Area code ____ Phone __________________________ Fax ____________________________
I certify that the applicant named above has the disability indicated, and that s/he requires
technology to independently access telecommunications services.
Signature of professional ___________________________________ Date ________________
SECTION 3 TDDP APPLICANT INFORMATION
1) Person applying for equipment
Last name ____________________ First name _______________________ Middle initial _____
Date of birth (month/day/year) _____________________________________________________
Street address _________________________________________________________________
(Note: Equipment cannot be delivered to a PO Box; you must provide a street address)
City _________________________ State __________________________ Zip ____________
County (e.g. Allegheny, Snyder) ___________________________________________________
Person assisting applicant with this application, if any.
Name ___________________________________ Phone _______________________________
2) Name of parent or guardian (for applicant under age18)
3) Telephone number: home ( ) - other ( ) -
4) Annual income:
Applicant’s gross income only, including Social Security and/or pension income if applicable. Do
not include family/household income. If applicant has no income, please write NONE.
$____________________
5
5) Total number of members in family unit (including applicant):
Applicant ( 1 ) + number of other family members (- ___ ) = total members in family unit ( ____ )
6) My primary reason for using the TDDP is (check one):
o Cannot afford equipment
o Equipment available to me only through TDDP
o I could get the device paid for through other programs, but the system is too complex and
the wait is too long
7) These questions are optional (for reporting purposes only).
Race:
o Caucasian
o African-American
o Asian
o Latino
o Other (specify)_________
Gender:
o male
o female
8) Please tell us how you heard about the TDDP: ______________________________________
9) Applicant’s statement and signature
(Note: This application should be submitted no later than 30 days after you have signed and dated it.)
I certify that all information provided on this application is true, complete and correct. I understand
that if I purposely provide false information I may be subjected to legal action. Program officials
have my permission to verify the information provided. I certify that I have read, understand and
accept all conditions set forth in this application and have the ability to learn to use the equipment
I selected.
Applicant signature ____________________________________________ Date____________
Parent or legal guardian signature________________________________ Date____________
(if applicant is a minor, or has a legal guardian)
6
DOCUMENTATION REQUIRED FOR TDDP APPLICATION
Do you have all the documentation requested? To complete the TDDP
application, you must submit photocopies (since originals cannot be returned) of
the documentation listed below.
1. Proof of Applicant’s (including minors) Residence in Pennsylvania
Submit ONE of the following: copy of current driver’s license, non-driver I.D., utility bill, dated Social
Security correspondence, copies of W-2’s, school report card, or other documentation pre-printed
with the applicant’s name and address.
2. Proof of Applicant’s Income
Submit a copy of each item that applies to you.
Income statements including W-2’s, 1099s or award letters for retirement and/or Social Security
income. If you do not have a copy of your Social Security income statement you can call 1-800-772-
1213 and request a “Benefits Verification Letter”. Bank statements and pay stubs cannot be
accepted. If applicant has no income write “NONE”. Note: If the applicant is a minor child, income
requirements are based on the child’s income only, not family or household income.
3. Proof of Telephone Service
Submit a copy of ONE page of your most recent telephone bill with your telephone number appearing
on it. If phone service is shared in a residential facility, submit a statement on facility letterhead
signed by Administrator or Social Worker and include applicant’s name and phone number.
4. Certification of Disability
Have Section 2 of this application completed by one of the following licensed professionals:
physician, audiologist, speech pathologist, or representative of a qualified state agency (e.g. Office of
Vocational Rehabilitation Counselor, Department of Public Welfare or Social Security Administration
Case Worker). To avoid delays make sure the entire section is completed before submitting the
application.
IMPORTANT: If you are unsure of the type of equipment that will meet your needs, the TDDP encourages you to contact PA’s Assistive Technology Lending Library. The Lending Library (ATLL) allows you to borrow equipment (at no cost) to help you decide what will work for you. Also, equipment demonstrations can be arranged through one of the regional Assistive Technology Resource Centers (ATRCs) of Pennsylvania’s Initiative on Assistive Technology. Please contact the TDDP for more information on the Lending Library, ATRCs, and other resources. If none of the listed equipment will meet your needs, please contact the TDDP:
Phone: 800-204-7428 voice / 866-268-0579 TTY / Email: [email protected]
7
EQUIPMENT SELECTION
CATEGORY A:
Select only ONE device below that best fits your needs.
Amplified Phone Clarity XL50
Amplified Phone Serene Innovations HD-60J
Amplified Phone (cordless) Clarity C4205
Amplified Phone (cordless) Clarity C4220
Amplified Phone (cordless) Clarity C4230
Amplified Talking Phone Ameriphone Dialogue JV35
In-line Handset Amplifier Ameriphone
Amplified Photo Phone Serene Innovations HD-30P
Amplified Photo Phone Serene Innovations HD-40P
Captioned Phone CapTel
Captioned Phone CapTel USB (computer not included)
Photo Phone Doro MemoryPlus 319ph
Big Button Speakerphone Reizen
Voice Activated Dialer AblePhone 5000
Headset Phone Plantronics CT-14
Hands Free Speakerphone optional accessories:
o lapel mic
o headset mic
o air switch
o pillow switch
RC200
Voice Carryover Phone Ameriphone Dialogue VCO
TTY Superprint 4425
8
TTY with Large Visual Display Superprint Pro80
o Blue-Green LVD
o Rose-Red LVD
o Amber LVD
Superprint Pro80
o TTY Hearing Carryover with speakers Ameriphone Q90D
o TTY Voice Carryover Phone Uniphone 1140
o Talking Keyboard DynaWrite with PhoneIT
o Telephone Fluency System Casa Futura
o Deaf/Blind Communicator with Braille and TTY Humanware
CATEGORY B:
Select only ONE signaler below.
Loud Ring Signaler CrystalTone
Flashing Light Signaler Sonic Alert
Vibrating Signaler OmniPage Kit (receiver shown)
Lamp Flasher and Bed Shaker Clarity (only for use with Clarity XL50 and Clarity
C4230
NONE (No signaling device from Category B is needed.)
9
Checklist
After you have finished the TDDP application, read and check the boxes below to ensure you have
completed all components:
Answered all of the Applicant Information
Had the Certification signed by a qualified individual
Signed the Applicant’s Statement
Selected equipment that is right for you (Your equipment selection is FINAL)
ATTACH A COPY OF PROOF FOR EACH OF THE FOLLOWING:
__Proof that you live in Pennsylvania
__Proof of income
__Proof of home telephone service
Make a copy of your application for your records.
Return the completed ORIGINAL application (pages 3 through 6), along with
COPIES of required documentation to:
Telecommunication Device Distribution Program
Institute on Disabilities at
Temple University/ PIAT
Lisa Troy, TDDP Program Coordinator
1601 North Broad Street
USB Suite 610
Philadelphia, PA 19122-6024
1
PIAT PROGRAMS
At work, At home, In the community
Device Demonstrations
AT (Assistive Technology) demonstrations are hands-on
opportunities to learn more about different AT devices so individuals
and families can make an informed choice about what will work best
for them. Demonstrations are individually scheduled upon request.
Device Loans
Pennsylvanians of any age and ability can borrow AT devices, at no
cost, to try at work, school, home or in their neighborhoods. This
short-term loan program allows individuals with disabilities to “try
before they buy,” and helps them and their families make the right
choice before a device is purchased.
Recycled and Exchanged Equipment Partnership
Previously-owned devices are an affordable option instead of
buying new, and several options are available to Pennsylvanians.
These include a classified listing of used devices, an online auction
site and recycling programs that clean and repair devices for reuse.
Public Awareness Activities
Information and referral provides assistance via phone, e-mail or
U.S. Mail, about the availability of AT devices and services; AT
exhibits and presentations offer information at conferences, group
meetings, staff in-services, and other events; and individualized
assistance helps consumers navigate the maze of funding options
available to obtain needed AT.
2
Telecommunication Device Distribution Program
PIAT administers Pennsylvania’s Telecommunication Device
Distribution Program, through which eligible Pennsylvanians with
disabilities can obtain free telephone equipment to help improve
their ability to access the phone.
AT Training and Technical Assistance
AT training opportunities educate health care providers, educators,
employers, agency staff, as well as individuals with disabilities and
their families, increasing their AT-related knowledge and skills.
Technical assistance provides collaborative problem-solving with
public and private agencies to develop and improve policies related
to AT.
Information and Referral
800-204-7428 (voice)
866-268-0579 (TTY)
http://disabilities.temple.edu/programs/assistive/piat
COLLABORATORS
Pennsylvania Assistive Technology Foundation
www.patf.us
888-744-1938 (voice/TTY)
Disability Rights Network of Pennsylvania
www.drnpa.org 800-692-7443 (voice)
877-375-7139 (TTY)
Institute on Disabilities at Temple University, College of Education
Update 9/09 - aed
PIAT Assistive Technology Resource Centers Pennsylvania’s Initiative on Assistive Technology (PIAT) Counties Served: Bucks, Chester, Delaware, Montgomery, Philadelphia Contact: Sandi McNally Institute on Disabilities at Temple University 1601 N. Broad St., Suite 610, Philadelphia, PA 19122 (800) 204-PIAT (7428) or (215) 204-5967 Voice (866) 268-0579 TTY; (215) 204-9371 Fax E-mail: [email protected], www.disabilities.temple.edu Community Resources for Independence Counties Served: Clarion Crawford, Erie, Forest, Mercer, Venango, Warren Contact: Gregory Staub 3410 West 12
th Street, Erie, PA 16506
(800) 530-5541 or (814) 838-7222 Voice (814) 838-8115 TTY; (814) 838-8491 Fax E-mail: [email protected], www.crinet.org Three Rivers Center for Independent Living Counties Served: Allegheny, Armstrong, Beaver, Butler, Indiana, Lawrence, Westmoreland Contact: Kevin Huwe 900 Rebecca Avenue, Pittsburgh, PA 15221-2997 (800) 633-4588 Voice; (412) 371-7700 ext. 111 Voice (412) 371-6230 (TTY); (412) 371-9430 Fax E-mail: [email protected], www.trcil.org
Update 9/09 - aed
Life and Independence for Today Counties Served: Cameron, Clearfield, Elk, Jefferson, McKean, Potter Contact: staff 503 Arch Street Extension Saint Marys, PA 15857-1779 (800) 341-5438 Voice or (814) 781-3050 Voice (814) 781-1917 Fax/TTY E-mail: [email protected], www.liftcil.org United Cerebral Palsy of Central PA Counties Served: Adams, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Juniata, Lebanon, Mifflin, Perry, Snyder, York Contact: Jackie Wardle 925 Linda Lane, Camp Hill, PA 17011 1-800-998-4827 or (717) 737-3477 Voice/TTY (717) 737-9017 Fax E-mail: [email protected], www.ucpcentralpa.org Roads to Freedom Counties Served: Centre, Clinton, Columbia, Lycoming, Montour, Northumberland, Sullivan, Tioga, Union Contact: Ray Pysher 210 Market Street, Williamsport, PA 17701 (800) 984-7492 or (570) 327-9070 Voice (866) 842-5426 TTY, (570) 327-8610 Fax E-mail: [email protected], www.cilncp.org
Update 9/09 - aed
United Cerebral Palsy of N. Eastern PA Counties Served: Bradford, Lackawanna, Pike, Susquehanna, Wayne, Wyoming Contact: Linda Mesavage 425 Wyoming Avenue, Scranton, PA 18503 (877) 827-8324 NE PA Only, (570) 347-3357 Voice (570) 347-3117 TTY; (570) 341-5308 Fax E-mail: [email protected], www.ucpnepa.com Tri-County Patriots for Independent Living Counties Served: Bedford, Blair, Cambria, Fayette, Greene, Somerset, Washington Contact: Donya Smith 69 East Beau Street, Washington, PA 15301 (724) 223-5115 Voice, (724) 228-4028 (TTY) (724) 223-5119 Fax E-mail: [email protected], www.tripil.com Good Shepherd Rehab Hospital Counties Served: Berks, Carbon, Lancaster, Lehigh, Luzerne, Monroe, Northampton, Schuylkill Contact: Carrie Kane 850 South 5
th Street Allentown PA 18103
877-629-1717 or (610) 778-1015 Voice (610) 776-8375 Fax E-mail: [email protected], www.goodshepherdrehab.org
The Pennsylvania Assistive Technology Foundation (PATF) is a non-profit organization that provides low-interest loans for the purchase of assistive technology devices and services. Examples of items that may be eligible for funding include: adapted vehicles, home modifications, hearing and low-vision aids, elevators, stair glides and lifts, computers with specialized software and/or hardware, and seat lift chairs. Successful participation in this program may also improve your credit rating.
PATF services:
1. Pennsylvania residents who have a disability and older Pennsylvanians who need assistive technology.
2. People of all income levels. Applicants must have the ability to repay a loan.
Additional PATF facts:
1. The current interest rate for low-interest loans larger than $1,000 is 4.5%. The repayment period is based on the useful life of the device.
2. The interest rate for loans that range between $100 and $1,000 is 0%. The minimum monthly payment is $20.
3. If the borrower (consumer) is low-income – meaning has a household income of less than 200% of the federal poverty guidelines – a partial grant may be available if the applicant is interested in borrowing less than $1,000. For a family of one, the maximum income to be eligible for a partial grant is $15,600. For a family of two, the maximum income is $21,000.
For more information about PATF, please call 888-744-1938 or e-mail: [email protected]. The web address is: www.patf.us.
Pennsylvania’s
Assistive Technology Lending Library
Institute on Disabilities at Temple University College of Education
What is assistive technology?
An assistive technology device is any device used by a person with a disability in order to communicate, work, play, learn, do chores at home, or get around in the community. Assistive technology devices can increase the ability of individuals with disabilities and older adults to be independent, contributing, and included members of their communities.
Assistive technology services help people with disabilities identify, obtain, and use assistive technology devices.
What is Pennsylvania’s Assistive Technology Lending Library?
Pennsylvania’s Assistive Technology Lending Library is a free service which enables Pennsylvanians with disabilities of all ages to try a variety of assistive technology devices, in order to decide what device is best suited to their needs. Pennsylvania’s Assistive Technology Lending Library is supported by state dollars with additional funding from Pennsylvania’s Initiative on Assistive Technology (PIAT), vendors and contributions from users.
The inventory of Pennsylvania’s Assistive Technology Lending Library consists of assistive technology devices which can be easily shipped, do not require installation or permanent modifications and do not involve weight bearing. There are local branches of Pennsylvania’s Assistive Technology Lending Library across the Commonwealth, as well as regional Assistive Technology Resource Centers (ATRCs) that can help you learn more about the devices and how to borrow them. If you don’t know what you need, would like to see devices demonstrated, need help in learning to use the device, or if you successfully try a device and need help in acquiring it for your own use, the ATRC staff can help.
Pennsylvania’s Assistive Technology Lending Library is a free program available to all Pennsylvanians with disabilities, regardless of age or disability, who would like to try out assistive technology devices prior to purchasing them.
What devices are available through Pennsylvania’s Assistive Technology Lending Library?
There is a wide selection of devices for you to borrow, including devices that can help you: Communicate with others
Control your environment
Hear what others are saying
Do everyday activities
Access computers
Read printed materials If the device you want to try is not available in the inventory, the ATRC may be able to help you find other ways to borrow or try the device.
How does Pennsylvania’s Assistive Technology Lending Library work?
Requests to borrow equipment may be made by you, your family member, friend or advocate, or someone who is presently helping you with your assistive technology needs (e.g. therapist, teacher, rehabilitation counselor). For devices that are complicated, you may be asked to identify someone who is familiar with the device who will help you use it during a loan period. Employers, schools and university faculty may also borrow.
Return your completed application to the ATRC serving your region for processing.
After your application is received by the ATRC, you will be informed of an actual or approximate shipping date. Your device will be delivered to you, and is yours to use for the specified loan period. When the loan period is over, the device will be picked up and returned to the Lending Library. There is no cost to you for pick up or delivery of the device. Anyone interested in borrowing a device can get an application and view the equipment catalog online or an application can be requested by calling toll-free:
877-PA AT LEND (877-722-8536) voice/TTY
800-204-PIAT (800-204-7428) voice
866-268-0579 TTY
For more information
For more information about Pennsylvania’s Assistive Technology Lending Library or for the Assistive Technology Resource Center nearest you email: [email protected] or go to the website at http://disabilities.temple.edu/atlend
Institute on Disabilities at Temple University 1601 North Broad Street 610 University Services Building Philadelphia, PA 19122
800-204-7428 voice 866-268-0579 TTY Fax 215-204-9371 http://disabilities.temple.edu/atlend [email protected]
The Institute on Disabilities is Pennsylvania’s University Center for Excellence in Developmental Disabilities, Education, Research, and Service at Temple University. Pennsylvania’s Initiative on Assistive Technology (PIAT) is a program of the Institute on Disabilities. PIAT is funded by a grant from the U.S. Department of Education under the Assistive Technology Act of 1998, as amended.
This brochure is available in alternate formats, upon request.
