This government document is issued by Vocational Rehabilitation Agency for use in Georgia
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https://www.google.com/url?client=internal-element-cse&cx=450907bf5042c4844&q=https://gvs.georgia.gov/document/document/supported-employment-service-identification-and-agreement-form/download&sa=U&ved=2ahUKEwjb1cir1eOKAxVsU6QEHawxJqg4ChAWegQIBxAB&usg=AOvVaw1LDwEM5Ig8nlGY_SCoekDp