Can the plan be signed electronically?

Yes. Electronic signatures are generally enforceable under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted; ensure the signer consents and the record is retained.

Is notarization required in California?

Not typically for vocational rehabilitation plans; however, certain funding agreements or releases may require notarization. Verify with the funding agency or legal counsel.

What authentication level is recommended?

Use at minimum email or SMS code verification for signatures; require stronger identity proofing for funding authorizations or sensitive health information.

How should HIPAA-covered information be handled?

Treat health details as protected health information; limit access, obtain authorizations, and use HIPAA-compliant platforms under a BAA when required.

What if a field is incorrect after signing?

Create an amendment or addendum with a dated signature from the participant and approver documenting the correction; retain both original and amendment for audit purposes.

How long until services must start?

Start dates depend on authorization timelines and funding; document agreed start dates in the plan and record any delays with reasons and revised dates.

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California Vocational Rehabilitation Plan

California Vocational Rehabilitation Plan

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State of California

Division of Workers' Compensation

STATEMENT OF DECLINE OF VOCATIONAL REHABILITATION SERVICES

INSTRUCTIONS:

This form is to be used for injuries occurring on or after 1/1/94, when the employee declines rehabilitation following notification of medical eligibility. It must be signed by the employee and his/her representative, if any, and submitted by the claims administrator to the Rehabilitation Unit along with a properly completed Notice of Termination of Vocational Rehabilitation Services (DWC Form RU-105). If a Rehabilitation Unit case does not exist, it must be accompanied by a Case Initiation Document (DWC Form RU-101).

Employee Name:

M.I.

RU Case #

NOTICE TO EMPLOYEE

The purpose of this form is to formally record your desire to end your right to rehabilitation benefits. If you decline rehabilitation services, your right to rehabilitation services will end. This means your employer will not be required to provide rehabilitation services to you at a later date, unless otherwise determined pursuant to the Rules and Regulations of the Workers' Compensation Appeals Board in accordance with Labor Code Section 5410.

DESCRIPTION OF VOCATIONAL REHABILITATION SERVICES

If you had a work-related injury or illness which prevents you from doing your former job and your employer cannot take you back, you are entitled to receive rehabilitation services. The amount of services you receive will depend on your needs and abilities.

Vocational rehabilitation services help you to get another job, through job placement or training, whichever is best for you. The rehabilitation costs, including counselor fees and maintenance allowance, are paid by your employer subject to the statutory limits. You have a right to an evaluation to determine the vocational options available to you prior to making this decision. Your right to rehabilitation is separate from your other workers' compensation benefits and cannot under the Labor Code be terminated by a cash payment to you. If you are not ready to participate now in rehabilitation, but might be later, it may be possible to delay your participation in rehabilitation for a period of time.

If you want more information, you may contact an Information and Assistance officer with the Division of Workers' Compensation, at no charge, or you may contact an attorney.

STATEMENT OF DECLINATION

This form must be signed by the injured employee.

The injured employee states:

I have read this Statement of Decline of Vocational Rehabilitation Services.

I have received the pamphlet Help in Returning to Work-94.

I decline rehabilitation.

I understand by signing this form I am giving up a service to which I am entitled.

EMPLOYEE'S SIGNATURE

Date:

Representative's signature, if any.

The representative states:

I have reviewed this form with my client and

I have explained the effects of declining vocational rehabilitation benefits.

EMPLOYEE'S REPRESENTATIVE'S SIGNATURE:

Date:

REHABILITATION UNIT USE ONLY

State of California

DWC Form RU-107A (1/94)

What the California Vocational Rehabilitation Plan Is and who it serves

The California Vocational Rehabilitation Plan documents a participant's goals, supports, and services for returning to or entering the workforce with reasonable accommodations. Typically prepared by a vocational rehabilitation counselor in coordination with the participant, the plan captures medical, educational, employment history, functional limitations, required assistive services, timelines, and measurable outcomes. It is used by state vocational rehabilitation agencies, third-party providers, employers, and service coordinators to align funding, set milestones, and monitor progress toward employment objectives under state program rules and applicable federal nondiscrimination requirements.

Why a clear, compliant plan matters

A complete California Vocational Rehabilitation Plan clarifies responsibilities, supports eligibility determinations, and documents accommodations. Properly executed plans reduce disputes, enable access to services, and create an auditable record for funding and program oversight under state and federal rules, while respecting participant rights.

Who prepares and relies on the plan

Accurate completion benefits all parties by creating a shared, defensible roadmap for achieving employment outcomes.

Vocational rehabilitation counselors and case managers who assess needs, document services, and monitor milestones.
Participants and their representatives who review goals, authorize services, and confirm consent and participation.
Employers, service vendors, and benefits coordinators who provide workplace accommodations and verify service delivery.

Step-by-step: completing a California Vocational Rehabilitation Plan

Follow these sequential steps to prepare a usable, compliant plan that aligns assessments, goals, and required services.

01

Collect Intake: Gather medical records, education, employment history, and functional assessments.
02

Assess Needs: Document functional limitations, transferable skills, and barriers to employment.
03

Define Goals: Set measurable employment goals, timelines, and success criteria.
04

Assign Services: Specify providers, accommodations, training, and payment sources.

Core elements every professional plan should include

A complete plan balances assessment data with concrete actions and measurable timelines so progress and funding decisions are defensible.

Participant profile

Basic demographics, contact details, education, work history, and benefits status to establish identity and eligibility parameters.

Functional assessment

Objective description of limitations and capabilities tied to work tasks, including standardized test results or clinician reports when available.

Employment objective

Clear vocational goal, target SOC code or job title, expected hours and wage range, and any negotiated accommodations.

Services matrix

Enumerated services (training, assistive tech, counseling), assigned providers, start/end dates, and estimated costs for each line item.

Milestones and metrics

Measurable interim checkpoints (skills acquired, applications submitted) with dates to monitor progress toward the employment objective.

Consent and responsibilities

Signatures, data-sharing consents, participant responsibilities, and dispute-resolution steps required for program compliance.

Essential personal and administrative data fields

Full legal name: Participant's official name

Contact information: Address, phone, email

Date of birth: MM/DD/YYYY

Primary diagnosis: Functional impairment summary

Funding source: Agency or payer name

Plan effective date: MM/DD/YYYY

Common compliance risks and their consequences

Missing signatures: May void funding or delay service authorization

Incorrect dates: Can create audit gaps and eligibility disputes

Insufficient service detail: Leads to denials or partial reimbursement

Unauthorized data sharing: Potential HIPAA violations and civil penalties

Inaccurate cost estimates: Budget overruns and funding shortfalls

Failure to document progress: Program closure or requirement to repay funds

How plans move from draft to funded services

A typical workflow moves assessment findings into an approved plan, authorizes services, and then tracks delivery and outcomes.

Drafting: Counselor compiles assessments and proposes services.
Review: Participant and approver review plan details and costs.
Authorization: Agency or payer confirms funding and provider assignments.
Delivery: Services are scheduled, delivered, and progress recorded.

Online customization: recommended field and workflow settings

Configure your digital form to capture required fields, enforce formats, and route approvals automatically.

Field	Configuration
Effective Date	MM/DD/YYYY input mask; required
Provider selection	Dropdown with provider IDs; conditional fields
Cost estimate	Currency field with validation
Approval workflow	Two-step routing: counselor → supervisor

Technical options for secure e-submission and signatures

Choose a platform that supports audit trails, retention, and the authentication level required by your agency or funding source.

Document formats: PDF, DOCX supported
Authentication: Email, SMS code, or advanced signer verification
Integrations: Connectors to Microsoft 365, Google Workspace, NetSuite, Salesforce

Practical tips to complete plans accurately and efficiently

Adopt consistent formats and version control to reduce rework and support audits.

Standardize templates

Use a single, agency-approved template with required fields and validation rules to reduce omissions and speed approvals.

Validate identifiers

Confirm participant identifiers (name, DOB) against government ID to avoid payment or eligibility errors.

Track sign-off order

Capture participant consent, counselor signature, and supervisor approval in sequence and record timestamps for auditability.

Preserve audit trails

Keep tamper-evident copies with time-stamped audit logs and clear file naming to simplify reviews and appeal processes.

eSignature vendor comparison for signing and delivering plans

Compare core pricing and enterprise features relevant to secure plan execution. signNow is listed first per vendor-comparison conventions.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies	Varies	Varies	Varies
Bulk Send	Yes	Varies	Varies	Varies	Varies
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Frequently asked questions and troubleshooting

Answers to common questions about completing, signing, and storing the California Vocational Rehabilitation Plan.

Need help? Contact support

Can the plan be signed electronically?
Yes. Electronic signatures are generally enforceable under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted; ensure the signer consents and the record is retained.
Is notarization required in California?
Not typically for vocational rehabilitation plans; however, certain funding agreements or releases may require notarization. Verify with the funding agency or legal counsel.
What authentication level is recommended?
Use at minimum email or SMS code verification for signatures; require stronger identity proofing for funding authorizations or sensitive health information.
How should HIPAA-covered information be handled?
Treat health details as protected health information; limit access, obtain authorizations, and use HIPAA-compliant platforms under a BAA when required.
What if a field is incorrect after signing?
Create an amendment or addendum with a dated signature from the participant and approver documenting the correction; retain both original and amendment for audit purposes.
How long until services must start?
Start dates depend on authorization timelines and funding; document agreed start dates in the plan and record any delays with reasons and revised dates.

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