Social Security Administration TTW Form 1365

<<DVRSSA-1365.pdf>>

Hi,

During the recent Vermont Interactive Television Conference on the Ticket To Work we said we would send you the attached SSA Form 1365.  We want you to have the tools you need to effectively partner with consumers and VR Counselors as you work the TTW process together.  The attached is the form that needs to be filled out, signed (by both the individual and the VR counselor), and faxed to Cecile Sherburn to document assignment of an individual's ticket to VR (and our EN partner).

If the form is filled out electronically, it needs to be printed, signed, and faxed to Cecile for processing.

Our hope is that providing you a copy of this form will expedite the process with our joint consumer customers.

Let me know of any questions you may have,
Jerry

Cecile's contact information:

Cecile R. Sherburn
Ticket To Work Coordinator & VR Administrative Assistant
Vocational Rehabilitation of Vermont
Weeks 1A
103 S Main St
Waterbury, VT 05671-2303
Phone: 1-802-241-2447 v/tty
Toll Free: 1-800-361-1239
Fax: 1-802-241-3359
Email: [log in to unmask]

Jerry Wood

Supported Employment Coordinator
VocRehab Vermont
103 South Main Street, Weeks 1A
Waterbury, Vt 05671-2303
[log in to unmask]
802-241-2195

PPlease consider the environment before printing this e-mail


This email message may contain privileged and/or confidential information. If you are not the intended recipient(s), you are hereby notified that any dissemination, distribution, or copying of this email message is strictly prohibited. If you have received this message in error, please immediately notify the sender and delete this email message from your computer. CAUTION: The Agency of Human Services cannot ensure the confidentiality or security of email transmissions.