ESS-C-413 Highly Challenged Criteria Form (Rev. 2022-09-13)

Form Number: 

ESS-C-413

The ESS-C-413 Highly Challenged Criteria Form form is only used in the Supported Employment (SE) Contract. The ESS-C-413 Highly Challenged Criteria Form can be used by either the DRS Counselor or the Contractor to request Highly Challenged Supported Employment Services for the individual. The need for SEHC services may be determined at the beginning of services or once the individual has begun receiving services. The EC may determine after working with the individual that they require more extensive and intensive support than originally believed and should submit the ESS-C-413 Highly Challenged Criteria Form with supporting documentation to the DRS Counselor requesting to change the service to SE HC from SE Regular.

Document: 

File Origination or Revision Date: 

Revised 2022-09-13