VOCATIONAL REHABILITATION

DIVISION

Client Services Handbook

Vocational Rehabilitation Division CUSTOMER SERVICES HANDBOOKAssisting People with Disabilities

to Go to Work

Thank you for contacting the Georgia Vocational Rehabilitation Agency (GVRA) / Vocational Rehabilitation (VR) Division. The purpose of the VR Division is to help eligible persons with physical, mental or emotional disabilities to prepare for a job, get a job and/or keep their current job.If you are looking for help in going to work, the VR Division will help you decide on a good work goal, and our team of VR professionals is ready to work with you to make employment a

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reality.This handbook will help you learn more about VR services. It gives you information about qualifying for services, the rehabilitation process, important facts about things you need to do, and your rights from the beginning to the end of the VR process. When you apply for services, a VR professional will go over the information in this handbook with you. You will then sign an acknowledgment form that you reviewed and received the handbook, and that you understand the information provided.Keep this booklet handy so that you can look at it as your go through your rehabilitation program. It will give you an idea of what to expect from the VR

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Division, and what the VR Division expects from you. If you have questions, VR staff will be able to help you. Also, visit our website at http://gvs.georgia.gov/ for extra information about the GVRA/VR Division.

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The Vocational Rehabilitation Process

YOUR RESPONSIBILITIES

You are the most important person in the vocational rehabilitation process, so your active participation is important to its success. You, your VR counselor and others on your rehabilitation team will work together to help you plan for, prepare for and achieve your employment goals.

Here is a list of the main things for you to do in order to help us serve you better:

• Be a part of your VR services by making your choices, needs and interests known to your counselor;

• Maintain regular communication, and meet with your VR counselor as required, throughout your vocational rehabilitation program;

• Keep and be on time for appointments with your VR counselor, other VR staff and service providers. When this is not possible, please let your VR counselor's

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office know as soon as possible so your appointment can be rescheduled;

• Give honest and complete information, and provide your VR counselor with access to information and records that will help your VR counselor in making decisions about your eligibility, your services, and your financial need;

• Be sure to tell your VR counselor about changes in your situation; for example, changes in your address, phone number, medical or psychological condition, as well as changes in your SSI/SSDI check and other finances.

YOUR RIGHTS

The VR Division wants you to succeed in your rehabilitation program! We also want to make sure VR staff are being fair and helpful to you. You have the right:

• To apply for services;• To be considered for services without

regard to your gender, age, race, Page | 6

birthplace, nationality, religion, sexual orientation or type of disability;

• To be tested to find out if the VR Division can help you with employment related services;

• To have enough information to make the right informed choices from options available to you throughout the rehabilitation process. Informed choice means we provide the pros and cons for each of your options in order to help you make the best choices. Your choices include the choice of your work goal; the specific vocational rehabilitation services you are to get; the providers from whom you get services; and how to obtain and/or pay for your Individualized Plan for Employment (IPE/Work Plan) services;

• To know of any decisions that affect your case, the reasons for those decisions, and to know about important changes in your process before they happen;

• To make a written appeal of any decision affecting your case;

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• To know that your personal information will be kept private within the limits of the law;

• To request consideration for an exception to policy due to specialized needs or unusual circumstances;

• To ask for help and/or guidance from the GVRA/VR Customer Care Unit ;

• To ask for help and/or guidance from the Client Assistance Program.

APPLICATION

Any person who is available for assessment and services in the state of Georgia, and who has a physical, mental or emotional disability that interferes with his or her ability to work, may apply for vocational rehabilitation services. A VR staff member will help you in filling out an application for services. By finishing an application, you are letting us know you want to go to work.

It is important that you understand that your participation in the VR Division program could

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affect benefits you may be receiving, such as Social Security (SSI and SSDI), Food Stamps or Georgia Temporary Assistance for Needy Families (TANF). For example, your benefits may decrease or be stopped once you go to work and earn money.

ELIGIBILITY

To be eligible for vocational rehabilitation services, you must have a physical, mental or emotional disability that seriously interferes with your ability to work. You must also have a need for, and be able to benefit from, vocational rehabilitation services to get ready for or go back to work or to stay on your job. If you receive Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) based on your own disability and you plan to go to work, you probably qualify for vocational rehabilitation services.

Your VR counselor will use your current medical, psychological, vocational and assessment information about your disability. But, if needed, and at no cost to you, your VR

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counselor will also get new information to help find out whether or not you qualify to get services.

ORDER OF SELECTION

Due to a limited budget, the Georgia Vocational Rehabilitation Division operates under an Order of Selection system. This system makes sure that people with the most serious disability related obstacles to employment are placed in the highest priority category and receive services first. Therefore, it is possible to qualify for services but be placed on a wait list for future assistance. If you cannot be served immediately, you will receive information and referral services to other programs that may be able to assist you in looking for employment or independent living needs.

WORK NEEDS ASSESSMENT

After you have been approved for services and assigned a priority category, you and your VR

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counselor will begin the process to develop your Individual Plan for Employment (IPE)/Work Plan. At that time, further tests may be required to help you determine the right vocational goal, and to identify the services needed to achieve that goal. This is called the needs assessment. Needs assessment activities may include additional medical, psychological or other specialist tests, as well as a vocational and/or work evaluation. (If you have been placed on the wait list, your plan will not be developed until you are moved from the wait list to the service list.)

VR staff wants you to achieve employment success. Your VR team will help you to use job market information, including data on occupational trends and earning potential, to identify the kind of jobs in which you are interested and for which you are suited. Once you and your VR counselor agree on what job would be appropriate and what services are needed to get that job, you are ready to move forward in the VR process.

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INDIVIDUALIZED PLAN FOR EMPLOYMENT (WORK PLAN)

Your VR counselor will help you to develop a work plan called the Individualized Plan for Employment (IPE/Work Plan) which will include:

• The agreed upon vocational goal;• Objectives and services that are necessary

to reach your vocational goal;• How your progress will be measured;• How the services will be provided;• Your responsibilities; and• The projected completion date of your

work plan.

Your IPE/Work Plan:

• May be developed with the help of a family member, guardian, advocate or other authorized representative;

• Must be completed using the VR Division Page | 12

IPE/Work Plan format;• Must be agreed upon and signed by both

you and your VR counselor before it takes effect;

• May require you to pay part of the costs of your services;

• Must be reviewed by you and your VR counselor at least once a year to review your progress and to determine if changes in your services are needed;

• Will take as much time to complete as is appropriate and reasonable based on your individual needs and approved services. The length of time will be different for each person.

VOCATIONAL SERVICES

VR services will include only those services that are necessary, reasonable, and appropriate for you to reach your vocational goal and to become employed. Services received through the VR Division depend upon the availability of VR Division funds. VR payment for some services may require

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that you meet our financial need criteria. Depending upon your financial need, you may be asked to share in the cost of some services. You may request that your counselor review any special needs or unusual circumstances for consideration of exceptional situations.

Services will be provided directly by VR staff or will be arranged through approved providers. You will be asked to help in choosing your service providers. In an effort to ensure your success, the VR Division defines each service a provider may provide, what credentials and qualifications the provider must have and the cost of the service. All services and items purchased for you must be approved, in advance, by your VR counselor.

You will be required to apply for and use comparable benefits (health insurance, the GI Bill, PELL, VA Benefits, etc.) which pay for some of the same services as the VR Division. Failure to apply for comparable benefits may affect the availability of VR funding assistance

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for that service. If you are offered a comparable benefit but choose not to accept it, the VR Division will not pay for that particular service. The VR Division will also consider other resources such as family resources and other financial awards when determining funding sources.

When you and your VR counselor agree that you are ready to work, VR staff will help you to become employed. Staff assistance varies according to individual needs, and may include resume development, interview preparation, job referrals and/or employer contact information. Finding the right job is important and your active participation is important. Many clients can and will find their own jobs. Others may need someone to assist them. Whatever your situation, VR Division staff will help make your adjustment to employment successful. After you are employed, VR staff will follow up with you to make sure that you are satisfied with your work.

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CASE CLOSURE

After you have completed the objectives of your IPE/Work Plan and have been working successfully at your job for at least 90 days, your case will be closed.

POST-EMPLOYMENT SERVICES

You may qualify for post-employment services, even after you have begun working and your case has been successfully closed. In this situation, VR can help you with short-term, relatively minor, and required services in order for you to keep or regain employment.

INFORMATION AND REFERRAL SERVICES

If at any time it is determined that you cannot benefit from VR services in terms of an employment outcome or that VR Division services are not appropriate for you, the VR Division will provide information and referral to other more appropriate resources to assist

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you with your needs.

PROTECTION, USE AND RELEASE OF PERSONAL INFORMATION

The Georgia Vocational Rehabilitation Agency/Vocational Rehabilitation Division protects your privacy by keeping all information about you confidential. The VR Division wants you to know why and how information in your case file is collected, protected, used and released.

In order to assist you in going to work, the VR Division will need a great deal of personal information about you. A VR staff person will ask for your name, address, birth date, social security number, and your educational, medical and employment history. You will need to provide information about your income and financial resources, and as appropriate, information about the income and resources of parents and/or any individuals who contribute to your support. Because the VR Division uses a team approach, your personal information will be shared with

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the VR professionals who are working to help you with your employment needs. All this information will be kept confidential and will be used to determine how vocational rehabilitation services can help you to find meaningful work.

Your file with the VR Division will be electronically maintained. Additionally, communication between you and your counselor and your VR team may also be via electronic means. Although confidentiality of electronically exchanged information cannot be guaranteed, the VR Division attempts to protect the confidentiality of information transmitted through the use of computers, email, facsimile machines, telephones, voicemail, answering machines, and other technology. The VR Division uses encrypted and/or password-protected Internet sites and/or email communications and voicemail. You are encouraged to also use encrypted or password protected sites and not share access to your email account with others who you do not want to know your personal information.

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Any information that you are not comfortable submitting electronically can be submitted in a manner that you

are comfortable with but it is your responsibility to make sure that it is provided in a timely manner.

Sometimes, in order to provide you with services, VR Division staff will need to share information about you with another person, agency or employer. In these situations, VR will need your written consent and can only share information that is necessary to help in the delivery of services. The VR Release of Information form states with whom the information is to be shared, the reason the information is to be shared, and the length of time the release is valid.

You may see or obtain copies of the information in your VR case file by requesting it in writing. Information that your VR counselor thinks will require detailed explanation may not be given directly to you but will be given to someone such as a physician or a psychologist who will be able to

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clearly explain it to you.

Georgia Vocational Rehabilitation Agency (GVRA) Customer Relations

GVRA Customer Relations can assist you with any VR-related customer service issues. To help you move toward your goal of employment, Customer Relations will provide assistance, help resolve issues and serve as a link to ensure that you receive excellent service in a timely manner.

GVRA Customer Relations staff are available to assist you in many ways, including:

Supplying information about VR;Presenting your requests to VR;Advocating for you;Negotiating for you;Mediating disputes;Solving communication problems;Providing you additional disability- related resources.

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You may reach the Customer Relations Unit by any of the following:Statewide toll-free #: 1-866-489-0001 Atlanta area number: 404-232-1998TeleRelay Service: 711Email: wecare@gvs.ga.gov

THE GEORGIA CLIENT ASSISTANCE PROGRAM

The Governor of Georgia has designated the Law Offices of Martin and Jones to operate the Client Assistance Program (CAP). CAP is independent of VR, and helps people with disabilities who are seeking or receiving VR services by providing information about the Federal Rehabilitation Act, including:

How the VR Division can assist you with employment;

Eligibility requirements for VR services;How you guide your own rehabilitation;The purpose of the Rehabilitation Act;Your rights as a program participant;

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Resolving disagreements about your rehabilitation case.

The Client Assistance Program may also assist you in the following ways:

Advising you of your rights;Solving communication problems;Teaching you how to make requests;Referring you to other agencies when appropriate;Negotiating for you;Mediating disputes;Advocating for you with the VR

Program and others;Presenting your requests to the VR Program; Obtaining legal representation when appropriate

You may reach the Client Assistance Program by any of the following:

Statewide Toll-Free Number 800-822-9727Atlanta Area Number 404-373-2040

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Georgia Relay Service No. 800-255-0135Fax Number 404-373-4110Web Site Address http://www.georgiacap.comEmail Address gacapdirector@georgiacap.comU. S. Mail Address: 123 North McDonough Street, Decatur GA 30030

TICKET TO WORK AND VOCATIONAL REHABILITATION

Ticket to Work (TTW) is a work incentive program created by the Social Security Administration (SSA). Under this Program, SSA provides recipients with a Ticket which may be used for work related services. If you have been issued a Ticket, please notify your VR counselor who will discuss how the Ticket to Work Program and VR can jointly assist you in becoming employed. If you would like to learn more about the Ticket to Work Program, please call toll free 1-866-968-7842 (TTY: 1-866-833-2967). Information is also available at the program's web site: https://yourtickettowork.com.

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A resource called the Work Incentives, Planning and Assistance Program is available for Social Security recipients with disabilities. Trained staff can provide information and assistance on how employment will impact an individual's disability benefits. VR staff can tell you how to contact this program, or you can call toll free 1-866-489-0001 (TTY: 1-866-373-7778) for additional information. We encourage you to take advantage of this valuable resource so that you can make informed choices about work.

AFFIDAVIT

The Georgia Security and Immigration Compliance Act (“GSICA”) requires that “every agency or political subdivision shall verify the lawful presence in the United States of any applicant for public benefits.” (O.C.G.A. § 50-36-1(b)).Therefore, you will be required to complete an affidavit prior to receiving any service.

VOTER REGISTRATIONPage | 24

The National Voter Registration Act is a law designed to make it easier for individuals to register to vote. You will be offered an opportunity to become a registered voter. O.C.G.A. § 50-36-1(e)(2) Affidavit

By executing this affidavit under oath, as an applicant for either Adult Education, Cash Allowance, Health Benefits and/or Business Loans, Certificate, License or Registration (BEP Vendors only) as referenced in O.C.G.A. § 50-36-1, from Georgia Vocational Rehabilitation Agency Vocational Rehabilitation Division, the undersigned applicant verifies one of the following with respect to my application for a public benefit:

1) _________ I am a United States citizen.

2) _________ I am a legal permanent resident of the United States.

3) _________ I am a qualified alien or non-Page | 25

immigrant under the Federal Immigration and Nationality Act with an alien number issued by the Department of Homeland Security or other federal immigration agency.

My alien number issued by the Department of Homeland Security or other federal immigration agency is:____________________.

The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at least one secure and verifiable document, as required by O.C.G.A. § 50-36-1(e)(1), with this affidavit.

The secure and verifiable document provided with this affidavit can best be classified as: ___________________________________________________________________.

In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent

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statement or representation in an affidavit shall be guilty of a violation of O.C.G.A. § 16-10-20, and face criminal penalties as allowed by such criminal statute.

Executed in ___________________ (city), __________________(state).

_____________________Signature of Applicant

_____________________Printed Name of Applicant

SUBSCRIBED AND SWORNBEFORE ME ON THIS THE___ DAY OF ___________, 20____

_________________________NOTARY PUBLIC My Commission Expires:

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S ec u r e a n d V e r i f i a b l e Do c u m e n t s U nd e r O .C . G .A. §

50 - 3 6 - 2 Issued August 1, 2011 by the

Office of the Attorney General, Georgia

The Illegal Immigration Reform and Enforcement Act of 2011 (“IIREA”) provides that “[n]ot later than August 1, 2011, the Attorney General shall provide and make public on theDepartment of Law’s website a list of acceptable secure and verifiable documents. The list shall be reviewed and updated annually by the Attorney General.” O.C.G.A. § 50-36-2(f). The Attorney General may modify this list on a more frequent basis, if necessary.

The following list of secure and verifiable documents, published under the authority of O.C.G.A.

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§ 50-36-2, contains documents that are verifiable for identification purposes, and documents on this list may not necessarily be indicative of residency or immigration status.

• A United States passport or passport card [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]

• A United States military identification card [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]

• A driver’s license issued by one of the United States, the District of Columbia, the Commonwealth of Puerto Rico, Guam, the Commonwealth of the Northern Marianas Islands, the United States Virgin Island, American Samoa, or the Swain Islands, provided that it contains a photograph of the bearer or lists sufficient identifying information regarding the bearer, such as name, date of birth, gender, height, eye color, and address to enable the identification of the bearer [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]

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• An identification card issued by one of the United States, the District of Columbia, the Commonwealth of Puerto Rico, Guam, the Commonwealth of the Northern Marianas Islands, the United States Virgin Island, American Samoa, or the Swain Islands, provided that it contains a photograph of the bearer or lists sufficient identifying information regarding the bearer, such as name, date of birth, gender, height, eye color, and address to enable the identification of the bearer [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]

• A tribal identification card of a federally recognized Native American tribe, provided that it contains a photograph of the bearer or lists sufficient identifying information regarding the bearer, such as name, date of birth, gender, height, eye color, and address to enablethe identification of the bearer. A listing of

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federally recognized Native American tribes may be found at: htt p :// www.b i a . g ov / W ho W e A re /B I A / O I S/ T r i b a l G ov er n m e n tS er v i c e s / T r i b a l D i rec t o r y /i nd e x .h t m [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]

• A United States Permanent Resident Card or Alien Registration Receipt Card [O.C.G.A.§ 50-36-2(b)(3); 8 CFR § 274a.2]

• An Employment Authorization Document that contains a photograph of the bearer[O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]

• A passport issued by a foreign government [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]

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• A Merchant Mariner Document or Merchant Mariner Credential issued by the United States Coast Guard [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]

• A Free and Secure Trade (FAST) card [O.C.G.A. § 50-36-2(b)(3); 22 CFR § 41.2]

• A NEXUS card [O.C.G.A. § 50-36-2(b)(3); 22 CFR § 41.2]

• A Secure Electronic Network for Travelers Rapid Inspection (SENTRI) card [O.C.G.A. § 50-36-2(b)(3); 22 CFR § 41.2]

• A driver’s license issued by a Canadian government authority [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]

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• A Certificate of Citizenship issued by the United States Department of Citizenship andImmigration Services (USCIS) (Form N-560 or Form N-561) [O.C.G.A. § 50-36-2(b)(3);6 CFR § 37.11]

• A Certificate of Naturalization issued by the United States Department of Citizenship andImmigration Services (USCIS) (Form N-550 or Form N-570) [O.C.G.A. § 50-36-2(b)(3);6 CFR § 37.11]

• In addition to the documents listed

herein, if, in administering a public benefit or program, an agency is required by federal law to accept a document for proof of or documentation of identity, that

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document will be deemed a secure and verifiable document solely for that particular program or administration of that particular public benefit. [O.C.G.A. § 50-36-2(c)]

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State of GeorgiaAgency-Based Registration ApplicationDeclaration Statement

Name:_____________ Date:__________________

IF YOU ARE NOT REGISTERED TO VOTE WHERE YOU LIVE NOW, WOULD YOU LIKE TO REGISTER TO VOTE HERE TODAY?

1) □ I am not a citizen of the United States of America.2) □ I am a citizen and I want to register to vote.3) □ I am already registered to vote.4) □ I do not want to register to vote.

Applying to register or declining to register to vote will not affect the amount of assistance that you will be provided by this agency. IF YOU DO NOT CHECK ANY BOX, YOU WILL BE CONSIDERED TO HAVE DECIDED NOT TO REGISTER TO

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VOTE AT THIS TIME.

If you would like help in filling out the voter registration application form, we will help you. The decision whether to seek or accept help is yours. You may fill out the application in private.

If you believe that someone has interfered with your right to register or to decline to register to vote or your right to privacy in deciding whether to register or in applying to register to vote, you may file a complaint with the Secretary of State, Elections Division at 802 West Tower, 2 Martin Luther King, Jr. Drive, SE, Atlanta, Georgia 30334 or by calling 404-656-2871.

If an applicant declines to register to vote, the declination shall be confidential and will be used only for voter registration purposes.

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COMMENTS/REMARKS:

If an applicant refuses to sign the registration application, count as a declination and mark box 4 on this form. Note under comments: "Refused to sign application." If either box 1, 3, or 4 is checked, place the form in the declination file. Retain all declinations for 24 months.

Form DS-95

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ACKNOWLEDGEMENT

I have received a copy of the Client Services Handbook from the Georgia Vocational Rehabilitation Agency/Vocational Rehabilitation Division and have reviewed it with a VR staff person. I understand my rights to confidentiality, to make informed choices about my vocational rehabilitation process, to contact the Client Assistance Program, and to appeal decisions made by my VR counselor. I also understand I have the responsibility to actively participate in my vocational rehabilitation process and to make every effort to go to work.

Customer Signature ________________

Date ________________

VR Program Copy

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ACKNOWLEDGEMENT

I have received a copy of the Customer Services Handbook from the Georgia Vocational Rehabilitation Agency/Vocational Rehabilitation Division and have reviewed it with a VR staff person. I understand my rights to confidentiality, to make informed choices about my vocational rehabilitation process, to contact the Client Assistance Program, and to appeal decisions made by my VR counselor. I also understand I have the responsibility to actively participate in my vocational rehabilitation process, and to make every effort to go to work.

Customer Signature ________________

Date _________________

Customer CopyPage | 39

GVRA/VR Service Area OfficesVR Division - West Service Area 1: Rome - (706) 295-6407 Counties Served: Bartow, Catoosa, Chattooga, Dade, Fannin, Floyd, Gilmer, Gordon, Haralson, Murray, Paulding, Pickens, Polk, Walker, and Whitfield

Service Area 4: Newnan - (770) 254-7210 Counties Served: Butts, Carroll, Coweta, Heard, Lamar, Meriwether, Pike, Spalding, Troup, and Upson

Service Area 8: Columbus - (706) 649-7400 Counties Served: Chattahoochee, Clay, Crisp, Dooly, Harris, Macon, Marion, Muscogee, Quitman, Randolph, Schley, Stewart, Sumter, Talbot, Taylor, and Webster

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VR Division – Metro Atlanta Service Area 3: Call (404) 657-2239 for Clayton, DeKalb, Fayette, Gwinnett, Henry, and Rockdale counties; Call (770) 909-2838 for Cherokee, Cobb, Fulton, and Douglas counties

VR Division - East Service Area 2: Gainesville – (770) 535-5930 Counties Served: Banks, Dawson, Forsyth, Franklin, Habersham, Hall, Hart, Lumpkin, Rabun, Stephens, Towns, Union, and White

Service Area 5: Athens - (706) 354-3900 Counties Served: Barrow, Clarke, Elbert, Greene, Jackson, Jasper, Madison, Morgan, Newton, Oconee, Oglethorpe, and Walton

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Service Area 6: Macon - (478) 757-4080 Counties Served: Baldwin, Bibb, Crawford, Houston, Jones, Monroe, Peach, Pulaski, Putnam, Twiggs, and Wilkinson

Service Area 7: Augusta - (706) 650-5600 Counties Served: Burke, Columbia, Glascock, Hancock, Jefferson, Jenkins, Lincoln, McDuffie, Richmond, Taliaferro, Warren, Washington, and Wilkes

VR Division – South Service Area 9: Dublin – (478) 275-6519 Counties Served: Appling, Bleckley, Candler, Dodge, Emanuel, Evans, Jeff Davis, Johnson, Laurens, Montgomery, Tattnall, Telfair, Toombs, Treutlen, Wayne, Wheeler, and Wilcox

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Service Area 10: Albany - (229) 430-4170 Counties Served: Baker, Calhoun, Colquitt, Decatur, Dougherty, Early, Grady, Lee, Miller, Mitchell, Seminole, Terrell, Thomas, and Worth

Service Area 11: Valdosta - (229) 333-2170 Counties Served: Atkinson, Bacon, Ben Hill, Berrien, Brantley, Brooks, Charlton, Clinch, Coffee, Cook, Echols, Irwin, Lanier, Lowndes, Pierce, Tift, Turner, and Ware

Service Area 12: Savannah - (912) 356-2226 Counties Served: Screven, Bryan, Bulloch, Camden, Chatham, Effingham, Glynn, Liberty, Long, McIntosh and Screven

To request an alternate format of this handbook, please contact your Service Area Office.

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Instructions This page is not intended to be part

of the handout

(Accessibility Editor's Note: The following is the described text for the Voter Registration page of the Client Services Handbook, which is not conducive to Braille or screen reader access.)

There is a tear-out form explaining that the National Voter Registration Act is a law designed to make it easier for individuals to register to vote, and that the prospective customer will be offered an opportunity to become a registered voter.

Here is the text on the form, which is titled State of Georgia, Agency-Based Registration Application, Declaration Statement. There is a place for the customer to insert his or her name, as

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well as the date.

If you were not registered to vote where you live now, would you like to register to vote here today? There are four choice boxes; the customer is asked to select one. One, I am not a citizen of the United States of America. Two, I am a citizen and I want to register to vote. Three, I am already registered to vote. Four, I do not want to register to vote.

Applying to register or declining to register to vote will not affect the amount of assistance that you will be provided by this agency. If you do not check any box, you will be considered to have decided not to register to vote at this time.

If you would like help in filling out the voter registration application form, we will help you. The decision whether to seek or accept help is yours. You may fill out the application in private.

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If you believe that someone has interfered with your right to register or to decline to register to vote or your right to privacy in deciding whether to register or in applying to register to vote, you may file a complaint with the Secretary of State, Elections Division at 802 West Tower, 2 Martin Luther King, Jr. Drive, SE, Atlanta, Georgia 30334 or by calling 404-656-2871.

If an applicant declines to register to vote, the declination shall be confidential and will be used only for voter registration purposes. If an applicant refuses to sign the registration application, count as a declination and mark box 4 on this form. Note under comments: "Refused to sign application." If either box 1, 3, or 4 is checked, place the form in the declination file. Retain all declinations for 24 months.

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Space is provided for comments and remarks.

There are two copies of an acknowledgement form that the client must sign and date. One copy is removed from the handbook and is placed in the VR file; the other is for the client's file. Here is the text on the acknowledgement form.

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