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II-H-1 HUMAN SERVICES REFERRAL TO VOCATIONAL REHABILITATION Department of Human Services Form DP 4028 Introduction The DP-4028 is a form developed by the Department of Human Services as part of an overall case data system to refer clients to other agencies and programs including Vocational Rehabilitation. Receipt of this form will indicate to the vocational rehabilitation counselor that one or more of the persons listed on the form is referred fo...
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How to fill out HUMAN SERVICES REFERRAL TO VOCATIONAL REHABILITATION

01
Obtain the HUMAN SERVICES REFERRAL TO VOCATIONAL REHABILITATION form from the appropriate agency or website.
02
Fill in the personal details of the individual seeking vocational rehabilitation, including their name, address, and contact information.
03
Provide details about the individual's medical condition or disability, including any relevant diagnosis.
04
Describe the individual's work history, including previous jobs and skills.
05
Specify the types of services needed for successful vocational rehabilitation, such as counseling, job training, or placement services.
06
Include any additional information or documentation that may assist in processing the referral.
07
Sign and date the form to certify that the information provided is accurate.
08
Submit the completed form to the designated vocational rehabilitation agency.

Who needs HUMAN SERVICES REFERRAL TO VOCATIONAL REHABILITATION?

01
Individuals with disabilities seeking assistance in finding and maintaining employment.
02
Those who require support in developing skills relevant to the job market.
03
People facing barriers to employment due to medical or psychological conditions.
04
Individuals who have received guidance or recommendations from social workers or medical professionals to seek vocational rehabilitation services.
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To qualify for VR services, an individual must: Have a physical or mental impairment that presents a substantial barrier to employment; and be able to benefit from VR services to achieve employment. Need VR services to prepare for a job, or to get, keep, or regain a job.
(6) Vocational rehabilitation referral The term “vocational rehabilitation referral” means any individual who is certified by the designated local agency as— (A) having a physical or mental disability which, for such individual, constitutes or results in a substantial handicap to employment, and (B) having been
The goal of vocational rehabilitation is to help you return to work as quickly as possible, to a job compatible with the work restrictions provided by your physician, with pay as close as possible to your pre-injury wages.
Eligibility Criteria Have a disability which results in barriers to employment. Need services to discover and prepare for employment. Need services to find and get new employment. Need services to keep or advance in employment.
To qualify for VR services, an individual must: Have a physical or mental impairment that presents a substantial barrier to employment; and be able to benefit from VR services to achieve employment. Need VR services to prepare for a job, or to get, keep, or regain a job.
Vocational rehabilitation, also abbreviated VR or voc rehab, is a process which enables persons with functional, psychological, developmental, cognitive, and emotional disabilities, impairments or health disabilities to overcome barriers to accessing, maintaining, or returning to employment or other useful occupations.
(6) Vocational rehabilitation referral The term “vocational rehabilitation referral” means any individual who is certified by the designated local agency as— (A) having a physical or mental disability which, for such individual, constitutes or results in a substantial handicap to employment, and (B) having been

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Human Services Referral to Vocational Rehabilitation is a process through which individuals with disabilities are referred to vocational rehabilitation services to help them gain or regain employment based on their specific needs and abilities.
Typically, referrals are filed by social workers, case managers, or individuals themselves if they are seeking assistance for disability-related employment challenges.
To fill out the referral, provide personal information of the individual, including their disability information, employment history, relevant medical information, and any services they may need to assist in their vocational rehabilitation.
The purpose of the referral is to connect individuals with necessary resources, support, and services to empower them to achieve gainful employment, enhancing their independence and quality of life.
The referral must report personal identification details, the nature of the disability, work history, any services currently received, specific rehabilitation needs, and other relevant medical or social information.
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