TX HHS Form 4117. Supported Employment/Employment Assistance Service Delivery Log

The Supported Employment/Employment Assistance Service Delivery Log (Form 4117) is a practical tool designed to track the delivery of employment services for individuals with disabilities. This form helps solve the problem of monitoring and recording the progress of employment assistance programs, ensuring that participants receive the necessary support and guidance to achieve their goals.

This log requires essential information such as individual name, local case number, date of services, service details, employee provided time, location, and comments. The form also allows for tracking of specific events or occurrences related to an individual's disability, including employment adaptations, supervision, and training. By recording these details, service providers can identify areas that require additional support and make data-driven decisions to improve program outcomes.

The Supported Employment/Employment Assistance Service Delivery Log is typically used by service providers working with individuals with disabilities who are seeking employment assistance or supported employment services. This form helps ensure that all necessary information is recorded and tracked, allowing for effective monitoring and evaluation of program progress. Key points to note include:

• Required information includes individual name, local case number, date of services, and service details.
• The form allows for tracking of specific events or occurrences related to an individual's disability.
• The log is used by service providers working with individuals with disabilities seeking employment assistance or supported employment services.