Vocational Rehabilitation Letter Templates

Five fill-in-the-blank letters for people working with a state vocational rehabilitation (VR) agency. Each one quotes only rules we checked on official sources, and asks the agency to answer in writing.

Five letters you can fill in and send to your VR counselor.

How these letters work

1. Pick a letter and read the rules it uses.
2. Fill in the boxes. Only a few are required. Anything you leave blank is left out.
3. Choose Build my letter. Your letter appears below the form, and your screen reader moves to it.
4. Copy, download, print, or listen to it. Sign it, keep a copy, and send it to your counselor.

Your answers stay in this browser tab. Nothing is sent to Amplify or anyone else unless you send the letter yourself.

Letter 1: Request for an independent assistive technology evaluation

Use this letter to ask your VR agency to assess your assistive technology needs, by a qualified evaluator who does not sell the equipment, and to include the technology you need in your plan.

Use this letter to ask for a test of what technology you need, and to get it written into your plan.

Rules this letter uses

• Before your plan is written, the agency does a full assessment of your strengths, needs and choices when more information is needed. The rule says: “a comprehensive assessment to determine the unique strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice” Source: 34 CFR 361.5(c)(5)(ii)
• The agency must make the listed services available when you need them for your job goal. The rule says: “the designated State unit must ensure that the following vocational rehabilitation services are available” Source: 34 CFR 361.48(b)
• Assistive and rehabilitation technology is one of the services on that list. The rule says: “Rehabilitation technology in accordance with the definition of that term in § 361.5(c)(45), including vehicular modification, telecommunications, sensory, and other technological aids and devices” Source: 34 CFR 361.48(b)(17)
• "Rehabilitation technology" includes assistive technology devices and services. The rule says: “The term includes rehabilitation engineering, assistive technology devices, and assistive technology services.” Source: 34 CFR 361.5(c)(45)
• Your plan must describe the specific services you need, including assistive technology and personal assistance services when appropriate. The rule says: “including, as appropriate, the provision of assistive technology devices, assistive technology services, and personal assistance services” Source: 34 CFR 361.46(a)(2)(i)
• The agency must give you, or help you get, the information you need to choose your services and who provides them. The rule says: “must provide the individual or the individual's representative, or assist the individual or the individual's representative in acquiring, information necessary to make an informed choice about the specific vocational rehabilitation services, including the providers of those services” Source: 34 CFR 361.52(c)
• You can ask for a review of any decision that affects your services. The rule says: “dissatisfied with any determination made by personnel of the designated State unit that affects the provision of vocational rehabilitation services may request” Source: 34 CFR 361.57(a)

Federal rules do not use the word "independent" for this evaluation. This letter asks for an evaluator who is independent of any vendor under your right to informed choice. It does not claim a separate legal right.

Fill in Letter 1

Letter 2: Notice of disagreement with my Individualized Plan for Employment (IPE)

Use this letter to tell your VR agency in writing that you disagree with all or part of your IPE, what you want instead, and to ask for review while your services continue.

Use this letter when you do not agree with your plan. It asks the agency to fix it and to keep your services going.

Rules this letter uses

• The agency must tell you, in writing, that you can develop all or part of your plan yourself or with help from someone else, such as an advocate. The rule says: “may develop all or part of the individualized plan for employment” Source: 34 CFR 361.45(c)(1)
• The agency must have written policies that let you make informed choices throughout the whole process. The rule says: “must develop and implement written policies and procedures that enable an applicant or recipient of services to exercise informed choice throughout the vocational rehabilitation process” Source: 34 CFR 361.52(b)
• Your plan must describe the specific services you need, including assistive technology and personal assistance services when appropriate. The rule says: “including, as appropriate, the provision of assistive technology devices, assistive technology services, and personal assistance services” Source: 34 CFR 361.46(a)(2)(i)
• Your plan must include timelines for when services start and when you reach your job goal. The rule says: “Include timelines for the achievement of the employment outcome and for the initiation of services” Source: 34 CFR 361.46(a)(4)
• You can ask for a review of any decision that affects your services. The rule says: “dissatisfied with any determination made by personnel of the designated State unit that affects the provision of vocational rehabilitation services may request” Source: 34 CFR 361.57(a)
• While your appeal is pending, the agency may not suspend, reduce or end services you are receiving, unless you ask it to or there is evidence of fraud. The rule says: “The State unit may not institute a suspension, reduction, or termination of vocational rehabilitation services being provided to an applicant or recipient” Source: 34 CFR 361.57(b)(4)
• Mediation must be offered at least whenever you ask for a hearing. It is voluntary, confidential, and the state pays for it. The rule says: “The costs of the mediation process must be paid by the State” Source: 34 CFR 361.57(d)(5)
• An impartial hearing must be held within 60 days of your request, unless the dispute is resolved first or you agree to a specific extension. The rule says: “must be held within 60 days of an applicant's or recipient 's request for review of a determination made by personnel of the State unit” Source: 34 CFR 361.57(e)(1)
• The agency must give you a copy of your plan and every amendment, in your mode of communication (for example, accessible electronic format). The rule says: “A copy of the individualized plan for employment and a copy of any amendments to the individualized plan for employment are provided to the eligible individual” Source: 34 CFR 361.45(d)(4)
• You may ask the District Administrator for an administrative review within one year, orally or in writing. The rule says: “Be made orally or in writing to the District Administrator” Source: 9 CCR 7353(a)(2)
• A fair hearing request must be made in writing within one year to DOR Legal Affairs or by email to appealsinfo@dor.ca.gov. The rule says: “Be made in writing and directed to the Department of Rehabilitation, Legal Affairs or sent by electronic mail to appealsinfo@dor.ca.gov” Source: 9 CCR 7354(a)(2)
• Ask for a due process hearing in writing within 30 days after VRNH tells you its decision or after an alternative dispute process ends. If writing is a burden because of your disability, they must accept another mode. The rule says: “The written request for a hearing shall be made within 30 days after the NHVR notifies the individual of its determination or completion of an alternative dispute resolution procedure” Source: N.H. Admin. Rules Ed 1021.07(a)

California: to ask for mediation or a fair hearing, also send form DR 107 (see the California section of the Agency Timeline Directory). New Hampshire: your written hearing request must be made within 30 days.

Fill in Letter 2

Letter 3: Request for review of my priority category (order of selection)

If your state has a waiting list (an "order of selection"), use this letter to ask the agency to review the priority category you were placed in, using the seven functional capacities in the federal definition.

If you were put on a waiting list, use this letter to ask the agency to move you to a higher category.

Rules this letter uses

• The agency must tell you all the categories, which one you are in, and that you can appeal it. The rule says: “Notify all eligible individuals of the priority categories in a State's order of selection, their assignment to a particular category, and their right to appeal their category assignment” Source: 34 CFR 361.36(e)(2)
• Waiting-list categories must be based on how significant your disability is, using the federal definition. The rule says: “An order of selection must be based on a refinement of the three criteria in the definition of individual with a significant disability” Source: 34 CFR 361.36(d)(1)
• A "significant disability" means a serious limit in at least one of 7 areas: mobility, communication, self-care, self-direction, interpersonal skills, work tolerance, or work skills. The rule says: “seriously limits one or more functional capacities (such as mobility, communication, self-care, self-direction, interpersonal skills, work tolerance, or work skills) in terms of an employment outcome” Source: 34 CFR 361.5(c)(30)(i)
• Your category cannot be based on your type of disability, age, where you were referred from, the job you want, the cost of your services, or your income. The rule says: “An order of selection may not be based on any other factors, including” Source: 34 CFR 361.36(d)(2)
• If you were already getting services on your plan before the waiting list started, those services must continue. The rule says: “must continue to provide to an eligible individual all needed services listed on the individualized plan for employment if the individual had begun receiving such services prior to the effective date” Source: 34 CFR 361.36(e)(3)(ii)
• You can ask for a review of any decision that affects your services. The rule says: “dissatisfied with any determination made by personnel of the designated State unit that affects the provision of vocational rehabilitation services may request” Source: 34 CFR 361.57(a)
• If you ask in writing, the agency must give you the information in your record of services in a timely manner (with a narrow exception for information it decides may be harmful, which goes through a representative). The rule says: “if requested in writing by an applicant or recipient of services, the State unit must make all requested information in that individual's record of services accessible to and must release the information to the individual or the individual's representative in a timely manner” Source: 34 CFR 361.38(c)(1)
• If you are on a waiting list, the agency must still give you access to its information and referral system. The rule says: “Individuals who do not meet the order of selection criteria will have access to services provided through the information and referral system” Source: 34 CFR 361.36(a)(3)(iv)(B)

Each state writes its own categories and its own definition of "most significant disability." We have not yet copied California's or New Hampshire's category rules. Ask your agency for its written categories and criteria. This letter asks for them.

Fill in Letter 3

Letter 4: Ask DOR to correct an incomplete records release form (DR 260) (California)

Use this letter when the California Department of Rehabilitation (DOR) sends you a Form DR 260 (Consent to Release and Obtain Information) that leaves out records you asked for, limits the dates, or expires too soon, or when DOR staff will not talk with your advocate. It asks DOR to correct and re-send the form. To name your representative, also use Letter 5.

Use this letter if DOR sent you a release form that is wrong or missing things, or will not talk to your advocate.

Rules this letter uses

• A release form must say exactly what information it covers and who it goes to. The rule says: “Specifically state the information requested and to whom the request for information is directed.” Source: 9 CCR 7140.5(e)(1)
• Your consent should name you, name who gets the information, and describe what information is covered. The rule says: “The consent for disclosure shall be in writing and should, as appropriate, contain: (1) The name of the individual. (2) The name or title of the person or organization to whom the disclosure is to be made. (3) The extent or nature of the information to be disclosed.” Source: 9 CCR 7142(b)
• A consent lasts 30 days unless you write down a different period. The rule says: “The consent shall be valid for a period not to exceed 30 days from the date the consent is signed unless otherwise specified in writing by the individual” Source: 9 CCR 7142(c)
• If you ask in writing, the agency must release the information in your record to you or your representative in a timely manner. The rule says: “if requested in writing by an applicant or recipient of services, the State unit must make all requested information in that individual's record of services accessible to and must release the information to the individual or the individual's representative in a timely manner” Source: 34 CFR 361.38(c)(1)
• You can be represented at mediation and hearings by a lawyer or another advocate you choose. The rule says: “Allow an applicant or recipient to be represented during mediation sessions or due process hearings by counsel or other advocate selected by the applicant or recipient.” Source: 34 CFR 361.57(b)(3)(ii)
• The Rehabilitation Act itself says you can be represented at mediation or a hearing by a person you choose. The rule says: “include provisions to allow an applicant or an eligible individual to be represented in the mediation session or hearing by a person selected by the applicant or eligible individual” Source: 29 U.S.C. 722(c)(3)(B)
• In California, an authorized representative can be any person you designate to act for you. The rule says: “"Authorized Representative" means the parent of an unemancipated minor or permanent guardian or any person or entity who has been designated by the appellant to act on his/her behalf” Source: 9 CCR 7350(a)(3)
• California rules say you have a right to be represented at mediation. The rule says: “The individual has a right to be represented at the mediation.” Source: 9 CCR 7353.6(c)
• DOR says you can always bring a representative to meetings with DOR staff. The rule says: “It is always your right to bring a family member, representative or CAP advocate to meet with Department staff.” Source: DOR Client Assistance Program page

DOR’s official form for naming a representative in mediation and fair hearings is DR 108 Authorized Representative (PDF). Fill it out too and send it to the Mediation and Fair Hearing Office (appealsinfo@dor.ca.gov), or bring it to the hearing. DR 260 is not posted on DOR’s public forms page; your counselor issues it. Other DOR forms: DOR Forms.

Fill in Letter 4

Letter 5: Designation of authorized representative or advocate

Use this to name, in writing, the person you choose to help you and speak for you with your vocational rehabilitation (VR) agency: in meetings with staff, for your records, and in administrative review, mediation and fair hearings. Federal rules apply in every state; California rules are added when you choose California.

Use this to tell your VR agency, in writing, who your advocate is and what they can do for you.

Rules this letter uses

• You can be represented at mediation and hearings by a lawyer or another advocate you choose. The rule says: “Allow an applicant or recipient to be represented during mediation sessions or due process hearings by counsel or other advocate selected by the applicant or recipient.” Source: 34 CFR 361.57(b)(3)(ii)
• The Rehabilitation Act itself says you can be represented at mediation or a hearing by a person you choose. The rule says: “include provisions to allow an applicant or an eligible individual to be represented in the mediation session or hearing by a person selected by the applicant or eligible individual” Source: 29 U.S.C. 722(c)(3)(B)
• Your representative is anyone you choose, including a family member or an advocate. The rule says: “Individual's representative means any representative chosen by an applicant or eligible individual, as appropriate, including a parent, guardian, other family member, or advocate” Source: 34 CFR 361.5(c)(31)
• If you ask in writing, the agency must release the information in your record to you or your representative in a timely manner. The rule says: “if requested in writing by an applicant or recipient of services, the State unit must make all requested information in that individual's record of services accessible to and must release the information to the individual or the individual's representative in a timely manner” Source: 34 CFR 361.38(c)(1)
• In California, an authorized representative can be any person you designate to act for you. The rule says: “"Authorized Representative" means the parent of an unemancipated minor or permanent guardian or any person or entity who has been designated by the appellant to act on his/her behalf” Source: 9 CCR 7350(a)(3)
• California rules say you have a right to be represented at mediation. The rule says: “The individual has a right to be represented at the mediation.” Source: 9 CCR 7353.6(c)
• At a California DOR fair hearing, your authorized representative can come with you or represent you. The rule says: “The appellant may appear alone, with the authorized representative, or be represented by the authorized representative.” Source: 9 CCR 7355(a)
• DOR says you can always bring a representative to meetings with DOR staff. The rule says: “It is always your right to bring a family member, representative or CAP advocate to meet with Department staff.” Source: DOR Client Assistance Program page

In California, also fill out DOR’s official DR 108 Authorized Representative (PDF) for mediation and fair hearing, and sign a DR 260 release naming your representative for the records you want shared (Letter 4 helps if the DR 260 is wrong). Rules marked 9 CCR are California rules; other states have their own.

Fill in Letter 5

Last checked against official sources: October 22, 2026.