Three Easy Steps to Send an Authorization for Services to the Institute for Research, Assessment, and Professional Development

The name for the authorization has been changed by Sacramento to the following for Comprehensive Vocational Evaluations and Situational Assessments:

University Enterprises Corporation at CSUSB
5500 University Parkway
San Bernardino, CA 92407

Step 1: Create a DoR Authorization for Comprehensive Vocational Evaluation

• Rate: $180 per day for individual services - Comprehensive Vocational Evaluation
  
• Aware Vendor: #92407
  
• Location: #0092407
  
• Maximum allowable lodging in Orange County and Inland Empire is $84.00/night + taxes
  
• Maximum allowable lodging in San Diego County is $110.00/night + taxes
  
• Aware Service Provider Lodging Code: 165C
  
• Aware Service Provider Mileage Code for Private Vehicles: 167A
  
• Aware Service Provider Meals Code: 165D
  
• Aware Service Provider Other Code: 165E
  
• Aware Service Provider Parking Code: 165A

Create a DoR Authorization for Situational Assessment

• Rate: $40 per hour for individual services – Situational Assessment
  
• Aware Vendor: #92407
  
• Location: #0092407

Clients visiting Cal State San Bernardino facility for services:

Authorization will need to include $5 per day for parking. The Institute for Research, Assessment & Professional Development is located in Room CE-120, College of Education Building on the California State University San Bernardino campus. Purchase the parking permit at the main Parking Kiosk, located at 5500 University Parkway. The East Parking Structure is located adjacent to the College of Education Building. See campus map for directions.

Step 2: Complete a Comprehensive Voc. Eval. Referral Form or Situational Assessment Referral Form.

Save the Form as a word document on your local computer.

Sample CVE Authorization forms:

• CVE Authorization for new intakes
• CVE Authorization for TPP
• CVE Authorization for new IPE established client
• SA Authorization for new client

Travel Calculations:

• Service Provider Travel- Lodging
  # of nights x (variable rate/region $84-$110 + tax, per night), divided by # of clients
  1 each @ $ _________
• Service Provider Travel- Meals
  # of days x $34 per day, divided by # of clients
  1 each @ $ _________
• Service Provider Travel- Other
  Travel Time: # of hours x $35 per hour, divided by # of clients
  1 each @ $ _________
• Service Provider Transportation-Private Vehicle
  Mileage: # of miles round trip minus 50 miles x 55.5 cents, divided by # of clients
  1 each @ $ _________

Step 3: Submit completed Authorization, Referral Form, and Releases of Information via secure fax or e-mail (DO NOT MAIL ANY DOCUMENTS TO CSUSB).

E-mail: TheInstitute@csusb.edu - if you are unable to connect to your e-mail system through this link, copy & paste the e-mail address into your e-mail system.

Be sure to attach any relevant medical/psychological records to the e-mail with your Forms.

In lieu of e-mail you may also fax to the number listed below.

Fax: 909-922-7580

 

If you have further questions, please feel free to contact me. Thank you for the opportunity to be of service.

Dr. Connie McReynolds, Ph.D., Licensed Psychologist, CRC, PVE
Director, Institute for Research, Assessment, and Professional Development
College of Education, Room 120
California State University San Bernardino
San Bernardino, CA 92407
Phone: 909-537-5681
TTY: 909-537-5616
FAX:909-922-7580