Get VA 28-8872 1989-2023

Include Area Code 8H. EVALUATION CRITERIA 8J. EVALUATION SCHEDULE 8K. PROGRESS NOTES 9A. OBJECTIVE TWO Description VA FORM SEP 1989 28-8872 EXISTING STOCKS OF VA FORM 28-8872 MAR 1981 WILL BE USED. 1. DATE REHABILITATION PLAN 2. FIRST - MIDDLE - LAST NAME OF VETERAN 3. CLAIM NUMBER 4. SOCIAL SECURITY NUMBER C5. PROGRAM PLAN Check one 6A. TYPE OF PLAN IEEP - INDIVIDUALIZED EXTENDED EVALUATION WRITTEN REHABILITATION EMPLOYMENT ASSISTANCE ORIGINAL AMENDMENT If Amendment complete Items 6B and 6C 6C. DATE OF IWRP INDEPENDENT LIVING 6B. AMENDMENT NO. TO IWRP 7. PROGRAM GOAL NOTE INTERMEDIATE OBJECTIVES TO ACHIEVE PLANNED GOAL COVERED IN ITEMS 8 THRU 12. 8A. OBJECTIVE ONE Description 8B. ANTICIPATED COMPLETION DATE 8C. SERVICES PROVIDED 8D. DURATION OF SERVICES FROM Mo. Yr. 8E* NAME ADDRESS OF PERSON OR INSTITUTION PROVIDING SERVICES TO No* Yr. 8F* PERSON TO CONTACT If institution 8G* TELEPHONE NO. Continued on ITEM 9 CONTINUED 9I. EVALUATION PROCEDURE 10A. OBJECTIVE THREE Description 11. CONTINUATION SHEET CHECK BOX IF VA FORM 28-8872A REHABILITATION PLAN - CONTINUATION SHEET IS USED 12. CLOSURE STATEMENT I CERTIFY THAT I have participated in the development of this program plan* I understand it is my responsibility to cooperate in the program and make reasonable efforts on my behalf* There will be periodic and/or an annual review of the plan at which time the VA staff members and I will have a chance to jointly redevelop it. 1. DATE REHABILITATION PLAN 2. FIRST - MIDDLE - LAST NAME OF VETERAN 3. CLAIM NUMBER 4. SOCIAL SECURITY NUMBER C5. PROGRAM PLAN Check one 6A. TYPE OF PLAN IEEP - INDIVIDUALIZED EXTENDED EVALUATION WRITTEN REHABILITATION EMPLOYMENT ASSISTANCE ORIGINAL AMENDMENT If Amendment complete Items 6B and 6C 6C. PROGRAM PLAN Check one 6A. TYPE OF PLAN IEEP - INDIVIDUALIZED EXTENDED EVALUATION WRITTEN REHABILITATION EMPLOYMENT ASSISTANCE ORIGINAL AMENDMENT If Amendment complete Items 6B and 6C 6C. DATE OF IWRP INDEPENDENT LIVING 6B. AMENDMENT NO. TO IWRP 7. PROGRAM GOAL NOTE INTERMEDIATE OBJECTIVES TO ACHIEVE PLANNED GOAL COVERED IN ITEMS 8 THRU 12. DATE OF IWRP INDEPENDENT LIVING 6B. AMENDMENT NO. TO IWRP 7. PROGRAM GOAL NOTE INTERMEDIATE OBJECTIVES TO ACHIEVE PLANNED GOAL COVERED IN ITEMS 8 THRU 12. 8A. OBJECTIVE ONE Description 8B. ANTICIPATED COMPLETION DATE 8C. SERVICES PROVIDED 8D. DURATION OF SERVICES FROM Mo. 8A. OBJECTIVE ONE Description 8B. ANTICIPATED COMPLETION DATE 8C. SERVICES PROVIDED 8D. DURATION OF SERVICES FROM Mo. Yr. 8E* NAME ADDRESS OF PERSON OR INSTITUTION PROVIDING SERVICES TO No* Yr. 8F* PERSON TO CONTACT If institution 8G* TELEPHONE NO. Continued on ITEM 9 CONTINUED 9I. EVALUATION PROCEDURE 10A. OBJECTIVE THREE Description 11. CONTINUATION SHEET CHECK BOX IF VA FORM 28-8872A REHABILITATION PLAN - CONTINUATION SHEET IS USED 12. CLOSURE STATEMENT I CERTIFY THAT I have participated in the development of this program plan* I understand it is my responsibility to cooperate in the program and make reasonable efforts on my behalf* There will be periodic and/or an annual review of the plan at which time the VA staff members and I will have a chance to jointly redevelop it. .