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John has the disability label of "Mental Impairment" and is considered "non-verbal." John's PASS will be used for employment identification through four on the job experiences and will pay for OJT employer costs, transportation, and job coaching support. The yearly cost is $706.67. This PASS is for 3 years and a total amount of $2,120.00. This PASS comes from the Denver Regional SSA Office.
A. List the items or services you are buying or will need to buy in order to reach your goal. Be as specific as possible. Where applicable, include brand and model number of the item. (Do not include expenses you were paying prior to the beginning of your plan; only additional expenses incurred because of your plan can be approved.) Explain why each is needed to reach your goal. Also explain why less expensive alternatives will not meet your needs. Part III should show when you will purchase these items or services.

1. Item/service: On-the-Job Training employer training costs. Cost: $824.00
Vendor/provider: Employers to be determined, however, the following employers have been contacted and expressed interest in having me do on the job training at their business: Floral Creations, The Anytown Cafe, Local Food Market, and Anystate Anytown Ranch Inc.
Why needed: To obtain information about vocational interests, aptitudes, and support needs.
How will you pay for this item (e.g., one-time payment, monthly payment)? Weekly
How did you determine the cost? Estimate of minimum wage, 160 hours of training.

2. Item/service: Job Coach Support during On-the-Job trainings Cost: $700.00
Vendor/provider: Employment Services, Anytown, Anystate will provide some technical assistance and support to the schools around the assessment and job coaching for $32.00/hour. The school will provide additional support beyond what they currently have available for $10.00/hr
Why needed: I will need support to learn each job through Supported Employment services.
How will you pay for this item (e.g., one-time payment, monthly payment)? Monthly
How did you determine the cost? Quote from Employment Services and from Anytown School.

3. Item/service: Transportation to an from Work sites in Anytown, Anystate Cost: $596.00
Vendor/provider: SVATP (Supported Volunteer Anytown Transportation Providers)
Why needed: I live 30 miles from the nearest town and cannot drive.
How will you pay for this item (e.g., one-time payment, monthly payment)? One-time payment
How did you determine the cost? Estimate based on 1800 miles at $.32 per mile (my home is 30 miles one way from the nearest town, for 4 weeks of on-the-job evaluations and training or 20 days plus 10 additional days for interviews and additional assessments, or (30) 60 mile round trips.

B. If you propose to purchase, lease or rent a vehicle, please provide the following additional information: I am not proposing to purchase, rent or lease a vehicle.

1. Do you currently have a valid driver's license? [] Yes [X] No
If no, Part III must include the steps necessary to attain a driver's license.

2. Explain why alternate forms of transportation (e.g., public transportation, cabs, having friends or relatives drive you) will not allow you to reach your goal? N/A

3. If you are proposing to purchase a vehicle, explain why renting or leasing are not sufficient. N/A

4. If you are proposing to purchase a new vehicle, explain why purchasing a reliable used vehicle is not sufficient. N/A

5. Explain why you chose the particular vehicle rather than a less expensive model. N/A

C. If you propose to purchase computer equipment or other expensive equipment, please explain why a less expensive alternative (e.g., rental or purchase of less expensive equipment) will not allow you to reach your goal. Explain why you need the capabilities of the particular computer/equipment you identified. Also, if you attend (or will attend) a school with a computer lab for student use, explain why use of that facility is not sufficient to meet your needs.
I am not proposing to purchase any expensive equipment.
D. If you indicated in Part II that you have a college degree or specialized training, and your plan includes additional education or training, explain why the education/training you already received is not sufficient to allow you to be self-supporting. N/A