Plan for Achieving Self-Support

In order to minimize recontacts or processing delays, please complete all questions and provide thorough explanations where requested. If you need additional space to answer any questions, use the Remarks section or a separate sheet of paper.

Name: Clark SSN: 999-88-7777

PART I - YOUR GOAL

A. What is your work goal? (Show the specific job you expect to have at the end of the plan. If you are undergoing vocational evaluation to determine a feasible goal, show "VR Evaluation." If your goal involves a supported employment position, show the amount of job coaching you expect to need after the plan is completed compared to the amount you currently receive or will receive when you begin working.)

My plan is to be a Desktop Publishing Specialist. I expect to be able to perform the job duties at a pace that is comfortabe for me.

B. Describe the duties you will be expected to perform in this Job:

Desktop Publishing Specialist, will prepare documents, and graphic art for pre-press criteria. I will disign and select the size, style of type, column width and spacing on a computer that displays the entire document, including graphics, just as it will appear in print. I will be trained to use the equipment, and operation of complex programs.

C. How much do you currently earn (gross) each month in wages or self-employment income? $ 0 /month

How much do you expect to earn each month (gross) after your plan is completed? $ 1,200.00/month

How do you expect to find a job by the time your plan is completed?

I will have learned a service that is needed through out the Publishing industry. As a Desktop Publishing Specialist I will have obtained the knowledge base to perform many of the services businesses, and individuals need. I will have the necessary equipment, and software to perform the job.

D. If your goal involves self-employment, explain why you believe that operating your own business is more likely to result in self-support than if you worked for someone else.

There is a very open market for Desktop Publishing Specialist, many companies look for services to be provided at a professional level. The time and effort to produce the service does not require that it be located in a office setting, and by having less overhead I can provide competitive price based services. By obtaining all of the software, computers, and training that is needed I will be able to provide a quality service from a home based business. Because of my health, and the drug regimen I require this business is a great benefit to my ever changing condition due to medications. The training and equipment necessary can be used easily and produce professional quality work.

PART II - MEDICAL/VOCATIONAL/EDUCATIONAL BACKGROUND

A. What is the nature of your disability? HIV/AIDS

B. Explain any limitations you have because of your disability (e.g., limited amount of standing or lifting, etc.)

The medication that I take comes with many side effects. Often I am required to lay down for a brief periods of time. Walking long distances, and standing for a long amount time tire me. I am not able to do heavy lifting, are very strenuous work.

C. List the types of jobs you have had most often in the past few years and those you have had which are similar to your work goal. Also show how long you worked (i.e., how many months or years) in each type of job.

I have not worked in the past few years. I have never worked in this field before nor had a job in this field.

D. Check the block which describes the highest educational level you have completed:

[X] Elementary school [X] High school graduate or G.E.D. [X] Some college [ ] College graduate [ ] Post graduate courses [ ] Post graduate degree [X] Trade or Vocational School [ ] other (Specify):

If you completed college, list your major and degree(s) attained; if you completed one or more courses in a trade or vocational school, list the trade(s) you learned. I have a Certificate in Auto Body Repair from a vocational school.

E. Describe any other training you have received.

I have received some training in accounting, and business law.

F. Have you ever undergone a vocational evaluation? [ ]Yes [X] No

If yes, show the name, address and phone number of the person or organization who conducted the evaluation:

G. Have you ever had a Plan for Achieving Self-Support before? [ ]Yes [X] No

If yes, please answer the following:

When was your prior plan approved (month/year)?

When did it end (month/year)?

Why do you believe that this plan will be successful?

H. If someone is helping you prepare this plan, please give their name, address and telephone number:

I. If someone is helping you prepare this plan, please give their name, address and telephone number:

PART III - YOUR PLAN

List the steps, in sequence, that you will take to reach the goal and show the dates you expect to begin and complete each step. Be sure to show when you expect to purchase the items or services listed in Part IV.

Table Inserted Below:

PART IV - PLAN EXPENDITURES AND DISBURSEMENTS

A. List the items or services you are buying or will need to buy in order to reach your goal. Be as specific as possible. Where applicable, include brand and model number of the item. Do not include expenses you were paying prior to the beginning of your plan; only additional expenses incurred because of your plan can be approved. Explain why each is needed to reach your goal. Also explain why less expensive alternatives will not meet your needs. Part III should show when you will purchase these items or services.

1. Item/service: Basic Knowledge of Mac Operating Systems Cost: $ 150.00

Vendor/provider: Graphic Communications Company

Why needed: This the beginning courses in training in Desktop Publishing and working with a Macintosh computer system. There are no less expensive course study offered in this city.

How will you pay for this item? One time payment.

How did you determine the cost? The cost was provided to me by the instructor.

2. Item/service: Photo Shop Development 4.0 Cost: $ 150.00

Vendor/provider: Graphic Communications Company

Why needed: To learn color separation, transparency, C-print made from negatives. There are no less expensive course study offered in this city.

How will you pay for this item? One time payment.

How did you determine the cost? The cost was provided to me by the instructor.

3. Item/service: Quark Express Page layout Cost: $ 150.00

Vendor/provider: Graphic Communications Company

Why needed: To learn Bezier drawing tools, page positioning, resizing, scaling, and stacking, character manipulation, justification, tracking, kerning, picture importing. There are no less expensive course study offered in this city.

How will you pay for this item? One time payment.

How did you determine the cost? The cost was provided to me by the instructor.

4. Item/service: Adobe Illustrator Techniques Cost: $ 150.00

Vendor/provider: Graphic Communications Company

Why needed: To learn halftoning, separating, and trapping. Knowledge of color elements, create designs for print, multimedia and the Web. Knowledge of a seamless workflow across different platforms. There are no less expensive course study offered in this city.

How will you pay for this item? One time payment.

How did you determine the cost? The cost was provided to me by the instructor.

5. Item/service: Apple PowerMac G3 Minitower Mfr. # M6431LL/A Cost: $1,999.99

Service Contract 5-years $300.00

Tax $158.12

Total $2,458.11

Vendor/provider: CompUS Company

Why needed: To run necessary programs for printing production and graphics. The market is heavily supported by Mac operating systems, some people will also have IBM compatibles so versatility is very necessary.

How will you pay for this item? One time payment.

How did you determine the cost? I have looked through business store catalogs, mail order catalogs, and called around the city to check prices for this system.

6. Item/service: Viewsonic G773 17in Monitor 1280x1024 .26 Mfg. # G773 Cost: $ 499.95

Tax $34.37

Total $568.69

Vendor/provider: CompUS Company

Why needed: Monitor for the PowerMac Computer, it has enhanced features for the Mac system.

How will you pay for this item? One time payment.

How did you determine the cost? I have looked through business store catalogs, mail order catalogs, and called around the city to check prices for this monitor.

7. Item/service: Adobe Illustrator Mac Stock # TFC27772 Cost: $ 369.95

Tax $25.43

Total $395.38

Vendor/provider: Global Computer Supplies, or CompUS Company

Why needed: To provide professional publishing of printing of illustrations and online material This is the one of the industry leading software in providing professional publishing of working with illustration, and page formatting.

How will you pay for this item? One time payment.

How did you determine the cost? I have looked through business store catalogs, mail order catalogs, and called around the city to check prices for this software

8. Item/service: Adobe Photoshop Win/95 5.0 Stock # TFC28471 Cost: $ 188.95

Tax $12.99

Total $201.94

Vendor/provider: Global Computer Supplies, or CompUS Company

Why needed: To provide professional publishing of printing of photos and online material This is the one of the industry leading software in providing professional publishing of working with photographs, and other picture formats.

How will you pay for this item? One time payment.

How did you determine the cost? I have looked through business store catalogs, mail order catalogs, and called around the city to check prices for this software.

9. Item/service: Quark Xpress V4.0 MicroWarehouse #: GR10194 Cost: $ 699.95

Tax $48.12

Total $748.07

Vendor/provider: MicroWarehouse 1-800-999-9999

Why needed: To provide bezier-based drawing, layout, and design tools for additional versatility This is the one of the industry leading software in providing professional publishing of printed and online material. There are only two formats that are widely excepted, the other is listed above at number 13. It is necessary to have both to not limit your clients to formats they may not have.

How will you pay for this item? One time payment.

How did you determine the cost? I have looked through business store catalogs, mail order catalogs, and called around the city to check prices for this software

10. Item/service: Executive L-shaped desk # 323-010 Mfg. # 10282 Cost: $ 198.88

Global Napoli Leather chair # 8825BK Mfg. # 450/550 $199.99

Tax $27.42

Total $426.29

Vendor/provider: Office Depot

Why needed: Furniture for office & to hold equipment.

How will you pay for this item? One time payment.

How did you determine the cost? I have looked through business store catalogs, mail order catalogs, and called around the city to check prices for this furniture.

A. Item/service: Seagate 6.5GB IDE Hard Drive Mfg. # ST36531A Cost: $ 239.95

Tax $16.49

Total $256.44

Vendor/provider: CompUS Company

Why needed: Upgrade to hold additional programs on Compaq computer system

How will you pay for this item? One time payment.

How did you determine the cost? I have looked through business store catalogs, mail order catalogs, and called around the city to check prices for this hard drive.

11. Item/service: Hewlett-Packard LaserJet 5000 Laser Printer Mfg. # C4110A#ABA Cost: $1,489.95

Belkin Components PC Parallel Printer Cable, 20ft. $39.95

Service Contract 5-year $249.99

Tax $122.36

Total $1902.25

Vendor/provider: CompUS Company

Why needed: To produce black & white copies & graphics in letter perfect style.

How will you pay for this item? One time payment.

How did you determine the cost? I have looked through business store catalogs, mail order catalogs, and called around the city to check prices for this printer.

12. Item/service: Epson Stylus 1520 Color InkJet Printer Mfg. # C211001 Cost: $ 799.95

Epson Color Ink Cartridge for Stylus 400/600/800/1520 x2 =$47.90

Epson Black Ink Cartridge for Stylus 800/1520 x2 = $55.90

Belkin Components PC Parallel Printer Cable, 20ft. $39.95

Service Contract 5-year $150.00

Tax $75.19

Total $1168.89

Vendor/provider: CompUS Company

Why needed: To produce color copies & graphics with a high dpi output and perfect quality.

How will you pay for this item? One time payment.

How did you determine the cost? I have looked through business store catalogs, mail order catalogs, and called around the city to check prices for this printer.

13. Item/service: Hewlett-Packard LJ5000/N/GN Toner HP # C4129A x2 Cost: $ 349.99

Tax $24.05

Total $373.95

Vendor/provider: Global Computer Supplies

Why needed: I will need supplies of replacement ink toner for producing black & white copies & graphics

How will you pay for this item? One time payment.

How did you determine the cost? I have looked through business store catalogs, mail order catalogs, and called around the city to check prices for this toner.

14. Item/service: Hewlett Packard Surestore CD-Writer Plus 7200 Stock # TCF 28123 Surestore 7200i Cost: $ 409.00

Hewlett Packard 25-pack CD-R Media Disk $46.95

Memorex CD Label Maker kit $59.95

Memorex Clear labels for laser printer 100 sheets $49.99

Tax $38.90

Total $604.79

Vendor/provider: Global Computer Supplies

Why needed: To provide recorded compact disk service, and provide over 20 years data storage system

How will you pay for this item? One time payment.

How did you determine the cost? I have looked through business store catalogs, mail order catalogs, and called around the city to check prices for this CD-Writer.

15. Item/service: 2 Hon 100 series 4 drawer files # 588-525 Mfg. # JD425-X Cost: $ 198.88

2 Lock kits steel # 801-837 Mfg. # F24-X $30.00

2 Correll folding tables # 353-771 Mfg. # CF3096M-1 $80.00

Tax $21.23

Total $330.11

Vendor/provider: Office Depot

Why needed: Furniture for office & to hold equipment.

How will you pay for this item? One time payment.

How did you determine the cost? I have looked through business store catalogs, mail order catalogs, and called around the city to check prices for this furniture.

16. Item/service: Quicken Quickbook Pro 5.0 Cost: $ 179.99

Tax $12.37

Total $192.36

Vendor/provider: Office Depot

Why needed: Business Finance record keeping for checking accounts, & credit cards, write & print checks, payroll, business reports & graphs, accounts receivable & payable, and invoicing.

How will you pay for this item? One time payment.

How did you determine the cost? I have looked through business store catalogs, mail order catalogs, and called around the city to check prices for this software.

17. Item/service: Hewlett Packard ScanJet 6100 Cse Cost: $ 799.95

Service Contract 5-year $ 99.99

Tax $61.87

Total $961.81

Vendor/provider: CompUS Company

Why needed: To provide professionally scanned color copies, graphics, and pictures

How will you pay for this item? One time payment.

How did you determine the cost? I have looked through business store catalogs, mail order catalogs, and called around the city to check prices for this scanner.

18. Item/service: Microsoft Publisher 98 Cost: $ 99.99

Tax 8.87

Total 106.86

Vendor/provider: Office Depot

Why needed: To provide business applications of desktop publishing

How will you pay for this item? One time payment.

How did you determine the cost? I have looked through business store catalogs, mail order catalogs, and called around the city to check prices for this software

A. Item/service: Omni Page Pro 8.0 Cost: $ 123.99

Tax $8.52

Total $132.51

Vendor/provider: CompUS Company

Why needed: To provide Optical Character Recognition services

How will you pay for this item? One time payment.

How did you determine the cost? I have looked through business store catalogs, mail order catalogs, and called around the city to check prices for this software.

19. Item/service: Adobe Page Maker 6.5 Mac Stock # TFC27776 Cost: $ 599.95

Tax $41.24

Total $641.19

Vendor/provider: Global Computer Supplies

Why needed: This is the one of the industry leading software in providing professional publishing of printed and online material. There are only two formats that are widely excepted, the other is listed below at number 16. It is necessary to have both to not limit your clients to formats they may not have.

How will you pay for this item? One time payment.

How did you determine the cost? I have looked through business store catalogs, mail order catalogs, and called around the city to check prices for this software.

20. Item/service: Corel Draw 8.0 Full Version for Win95 & NT on CD Mfg. 80-ENG0 Cost: $ 479.95

Tax $32.99

Total $512.94

Vendor/provider: CompUS Company

Why needed: Provides tools for illustration, page layout, painting photo editing, and 3D modeling and rendering. Several utilities are included to provide support for scanning, tracing, OCR, font management, screen capture, OLE scripting and more..

How will you pay for this item? One time payment.

How did you determine the cost? I have looked through business store catalogs, mail order catalogs, and called around the city to check prices for this software

21. Item/service: Microsoft Office 97 Upgrade Win95/WinNT CDROM Mfg. 021-00703 Cost: $ 219.95

Tax $15.12

Total $235.07

Vendor/provider: CompUS Company

Why needed: To provide everything needed to organize information and manage everyday tasks.

A. Item/service: Olympus D-220L Digital Camera, 640 x 480 Resolution Mfg. 225-060 Cost: $ 299.95

Tax $20.62

Total $320.61

Vendor/provider: CompUS Company

Why needed: To provide Digital photography service

How will you pay for this item? One time payment.

How did you determine the cost? I have looked through business store catalogs, mail order catalogs, and called around the city to check prices for this digital camera.

22. Item/service: Working Capitol, Paper products, telepone, internet service, various materials, books & training manuals,utilities, insurances, miscellaneous expenses, networking hardware, power strips, office materials, magazine subscriptions, etc Total Cost: $4,586.80

Vendor/provider: Myself

Why needed: Without adequate working capital, it will be hard to succeed with a new business venture. Based on the budget figures I've prepared, I will need to generate enough start-up capital to cover some of my expenses during the year.

If you propose to purchase, lease or rent a vehicle, please provide the following additional information:

1. Do you currently have a valid driver's license? [ ] Yes [ ] No

If no, Part III must include the steps necessary to attain a driver's license

2. Explain why alternate forms of transportation (e.g., public transportation, cabs, having friends or relatives drive you) will not allow you to reach your goal?

3. If you are proposing to purchase a vehicle, explain why renting or leasing are not sufficient

4. If you are proposing to purchase a new vehicle, explain why purchasing a reliable used vehicle is not sufficient

5. Explain why you chose the particular vehicle rather than a less expensive model

C. If you propose to purchase computer equipment or other expensive equipment, please explain why a less expensive alternative (e.g., rental or purchase of less expensive equipment) will not allow you to reach your goal

Many of the programs and software are copy written. The user is limited to the number of times you can load the software. Also at times I will need to upgrade hardware in the computer systems and leases do not provide for alterations of their equipment. Desktop publishing is a rapidly changing field and I will need versatility to upgrade systems and software with out infringements. Also I want to keep initial operating budget to a minimum.

Explain why you need the capabilities of the particular computer/equipment you identified.

In order to be competitive in the market I will need the systems that is most supported in the market, that being Macintosh, and IBM compatibles. Other files and programs will need to be converted so that they can be read and turned into film, or color separated.

Also, if you attend (or will attend) a school with a computer lab for student use, explain why use of that facility is not sufficient to meet your needs.

The computer labs that I attend will suffice in the needs of education purposes, but to provide the services I will need my own equipment to set up and operate.

D. If you indicated in Part II that you have a college degree or specialized training, and your plan includes additional education or training, explain why the education/training you already received is not sufficient to allow you to be self-supporting.

I have never received specialized training in this field and will require additional training and education to provide myself with a self-supporting skills

PART V - INCOME/RESOURCE EXCLUSION

A. List any items you already own (e.g., equipment or property) which you will use to reach your goal. Show the value of each item and explain why you need each of the items to attain your goal.

1. Compaq Presario computer (IBM compatible): it will need to be upgraded with a bigger hard drive and more RAM, and additional software. Clients will have either IBM or Macintosh compatibles and I will need a system to read their file. Value: $1,649.00

2. NEC MultiSync XV14 Monitor: I need this monitor to view all programs on the Compaq computer. Value: $ 288.00

B. What money do you already have saved to pay for the expenses listed in Part IV? (Include cash on hand or money in a bank account)?

I have placed $100 into a separate bank account to keep track of all expenditures, and money saved to complete my PASS plan. I do not expect this plan to be approved by the time the first of my classes start. I will be using that money to pay for my first classes. Before September 1 hope to have heard a decision on the approval of this plan.

C. Other than earnings shown in Part I, what income do you receive (or expect to receive)? (Show how much you receive and how frequently you receive or expect to receive it.)

SSDI check of $606.00 each month.

D. How much of this money will you use each month to pay for these expenses listed in Part IV?

E. Do you plan to save any or all of this money for a future purchase which is necessary to complete your goal. [X] Yes [ ] No

If yes, explain how you will keep the money separate from other money you have. (If you will keep the savings in a separate bank account, give the name and address of the bank and the account number.)

National Bank, 9999 Main St., AnyTown, USA

F. What are your current living expenses each month. (e.g, rent, food, utilities, etc.) $ 456.00

If the amount you will have available for living expenses after making payments or saving money for your plan expensed is less than your current living expensed, explain how you will pay for those living expenses.

I will be applying for Supplemental Security Income benefits to pay for my living expenses.

G. Do you expect any other person or organization (e.g, Vocational Rehabilitation) to pay for or reimburse you for any part of the items and services listed in Part IV or to provide any other items or services you will need. [ ] Yes [X] No If yes please provide details

PART VI - REMARKS

Doing the time it takes to complete this plan I will be working with the Small Business Administration (SBA).They offer free up-dated small business seminars, workshops, small business development, to include marketing, management, and accounting, They also offer counseling. There will be many publication available to me by using the SBA and The Service Corps of Retired Executives (SCORE)

PART VII - AGREENENT

· Comply with all of the terms and conditions of the plan as approved by the Social Security Administration (SSA);

· Report any changes in my plan to SSA immediately;

· keep records and receipts of all expenditures I make under the plan until the next review of my plan at which time I will provide them to SSA;

· Use the income or resources set aside under the plan only to buy the items or services approved by SSA.

I realize that if I do not comply with the terms of the plan or if I use the income or resources set aside under my plan for any other purpose, SSA will count the income or resources that were excluded and I may have to repay the additional SSI received. I also realize that SSA may not approve any expenditures for which I do not submit receipts or other proof of payment.

I know that anyone who makes or causes to be made a false statement or representation of material fact in an application for use in determining a right to payment under the Social Security Act commits a crime punishable under Federal Law and/or State Law. I affirm that all the information I have given on this form is true.

Signature _________________________________________ Date___________________________

RECEIPT FOR YOUR PLAN FOR ACHIEVING SELF-SUPPORT

We received the plan for achieving self-support which you submitted. We will process your plan as soon as possible.

You should hear from us within ______ days. We will send you a letter telling you if your plan is approved. We will notify you if we need additional information before making a decision on your plan. We may ask you to modify your plan.

YOUR REPORTING AND RECORDKEEPING RESPONSIBILITIES

If we approve your plan, you must tell Social Security about any changes to your plan. You must tell us if:

· Your medical condition improves.

· You are unable to follow your plan.

· You decide not to pursue your goal or decide to pursue a different goal.

· You decide that you do not need to pay for any of the expenses you listed in your plan.

· Someone else pays for any of your plan expenses.

· You use the income or resources we exclude for a purpose other than the expenses specified in your plan.

· There are any other changes to your plan.

You must tell us about any of these things within 10 days following the month in which it happens. If you do not report any of these things, we may stop your plan.

You should also tell us if you decide that you need to pay for other expenses not listed in your plan in order to reach your goal. We may be able to modify your plan or change the amount of income we exclude so you can pay for the additional expenses.

YOU MUST KEEP RECEIPTS OR CANCELLED CHECKS TO SHOW WHAT EXPENSES YOU PAID FOR AS PART OP THE PLAN. You need to keep these receipts or canceled checks until we contact you to find out if you are still following your plan. When we contact you, we will ask to see the receipts or canceled checks. If you are not following the plan, you may have to pay back the some or all of the SSI you received.