OVR Forms

​Application 

• KY OVR Specialized Services Referral Form​
• Bioptic Driving Program Application​​

• OVR 7EO Employment Outcome Instructions 
• OVR 6C Cost Sharing Form
  
• OVR 6C - Cost Sharing Form Instructions
• OVR 19C Student Individual Responsibilities​​
  
• OVR 19C Student Individual Responsibilities Instructions 
• Trial Work Experience 
  
• ​Trial Work Experience Instructions
  
• Trial Work Experience Continuation Form​
  
• Trial Work Experience Continuation Instructions
  ​
  
• ​ Counselor Guide (Optional) for Required Data Elements for the IPE/Amendment or as needed​

Spanish Forms 

• 2022​ Consumer Guide - Spanish​​​
  
• OVR 2 Application - Spanish​
  
• OVR 2A Parent/Guardian Consent for Application
• Fact Sheet​
  
• Additional Supports Fact Sheet​​
  
• Voter Registration Questionnaire
  
• Order of Selection Letter​​​​​
  
• Eligibility Letter​
  
• Eligibility Letter Extension​​
  
• Potentially Eligible Student Form
  
• OVR 7 Individualized Plan for Employment (IPE)
  
• IPE Extension Agreement​
  
• IPE Amendment Spanish​​
  
• OVR 7EO Employment Outcome
  
• Functional Limitations​
  
• OVR 10 Receipt and Transferrable Items Agreement​​
  
• OVR 10A Security Agreement​​
  
• OVR12 Employment Follow Up​
  
• OVR 15A Authorization for Release of Personal or Protected Health Information​​
  
• OVR 15B Written Consent for Release of Personal or Protected Health Information in Possession of OVR​​
  
• Release of Information Interagency
• Verbal Exchange Release​​​
• PACE Acknowledgement Form​
  
• Pre-ETS Referral Form​
  
• Pre-ETS Referral Form Instructions​
  
• 511 Form​
  
• Appeal Rights Form P and A Spanish​
• OVR ​​Referral Form​​
  

• 2022​ Consumer Guide​​​​
  
• Consumer Payment Form​
• OVR 15A Authorization for Release of Personal or Protected Health Information​
  
• OVR 15A Instructions​​
• OVR 15B Written Consent for Release of Personal or Protected Health Information in Possession of OVR​​​​​​​​
  
• ​OVR 15B Instructions
  
• Verbal Exchange Release Form​​​
  
• Verbal Exchange Instructions​
  
• Verification for Subminimum Wage Employees​
  
• ​Verification for Subminimum Wage Employees Instructions​
  
• Case Review Form
  
• OVR 10A Security Agreement​​​
  
• OVR 12 Employment Follow-Up​​
  
• ​​Employment Follow-Up Instructions​
  
• Internet Website Exception Form
  
• Equipment Transfer​​​
  
• General Medical
  
• Visual Report Form​
  
• OVR 23 Consumer Mileage
  
• OVR23 Consumer Mileage Instructions​ 

Pre-ETS

• Pre-ETS Referral Form​
  

• ​Pre-ETS Referral Form Instructions​
  

• Pre-ETS Timesheet
  

• ​​Pre-ETS Timesheet Instructions
  

• Pre-ETS Report Form​​​
  

• Post-Secondary Inclusion Program Monthly Report​​
  

Other/Pre-ETS 

• Appeal Rights Form​​​​
• Eligibility Extension Outlook Instructions
• IPE Extension Outlook Instructions​
• Email Extension Instructions​
• Post Secondary Transition Program Worksheet
• Written Consent for Release of Information Between KCC Agencies​​
  
• ​Written Consent for Release Instructions
  
• OVR 10 Receipt and Transferrable Items Agreement​​​​
  
• Personal Care Attendant Tax Worksheet and Timesheet
• Interpreter Request Form
• OVR 19  Required Anticipated Sponsorship Notification​​
  
• ​OVR 19 Instructions​
  
• OVR 19A Training Participation Reconsideration Worksheet​​​
  
• OVR 19A Training Participation Reconsideration Worksheet Instructions
• OVR 19C Student Individual Responsibilities​​​​
  
• OVR 19C Student Individual Responsibilities Instructions​
• PFP Referral Form
• PFP Facilitator Survey​
• Support Service Provider Expectations

Job Placement 

• Job Placement Manual
  
• Fact Sheet
  
• Work Opportunity Tax Credit Forms and Information
  
• Closure Report​
  
• Job Placement-PACE Closure Form Instructions​
  
• Job Readiness Assessment (Consumer)
  
• Job Readiness Assessment Instructions
  
• Job Readiness Assessment (Counselor)
  
• Job Placement Initial Interview​​
  
• Job Placement Initial Interview Instructions​
  
• Agreement for On the Job Training Services​
  
• Agreement for On the Job Training Services Instructions
• On the Job Training Flyer​​
  
• On the Job Training Evaluation
  
• Customized​ Employment Handout
  
• Customized Employment - Put it to Work For Your Business
  
• Customized Employment - Office of Disability Employment Policy

PACE​

• PACE Letter​​​​
  
• PACE Acknowledgment Form​
  
• OVR 18A Multiple Disclosures​
  
• OVR 18B Employer Agreement for Training Site
  
• OVR 18D Weekly Timesheet and Evaluation
  
• OVR 18F Participant Responsibilities Agreement​
• ​SRG Claim Form​

Rehabilitation Technology & Driver Rehabilitation Technology Program

• Assistive Technology Staff Directory
• OVR 14 RT Referral Form
  
• OVR 14A DRTP Evaluation and Referral Form​
  
• OVR 14A DRTP Evaluation and Referral Form Instructions​​​​​
  
• Consent for Driver Services​
  
• Physician Consent Form
  
• Medical Report of Visual Disability​​​
• Driver Rehab TechnologyProgram Services Program Fees​​​​

Self-Employment

• Self Employment Process Flow Chart
  
• OVR 16A Self Employment Process Form
  
• ​​OVR 16A Self Employment Process Form Instructions
  
• OVR 16C Confidential Disclosure Agreement
  
• Feasibility Checklist for Consumers
  
• OVR 16B Counselor Review Form
  
• ​​​OVR 16B Counselor Review Form Instructions​
  
• Self Employment Tiers
  
• Start-Up Costs Table
  
• Calculation Worksheet
  
• Existing Business Checklist​
  
• Business Plan Checklist​
  

Social Security/Ticket to Work​

• Benefits Counseling Toolbox
  

• ky.db101.org​
  

• • Benefits Analysis SFM​​
    

  • Approved Benefits Counseling Providers​​​

• • Benefits Counseling Powerpoint
    
    
    

• ​​Social Security Incentive Form
  

• Kentucky Employment Network Listing
• Kentucky Employment Network Listing by County​​
  
• Social Security Administration Release Form​
  
• Social Security Calculation Chart​​
• Social Security Benefits Cheat Sheet
  
• Social Security Fact Sheet​
  
• 1619b Fact Sheet
  
• Adjustments to Social Security Checks​​
  
• Ticket to Work Regulations - 2008
• Ticket to Work Regulations - 2001
• Ticket to Work Timely Progress Guidelines​
  
• Benefits Planning Query Handbook​
• The Redbook: A Guide to Work Incentives
• Disability Materials for Groups and Organizations
• Faces and Facts of Disability
• Partnership Plus Fact Sheet​​​​