Senator CRANSTON. I am sure it does not sit well with the Nation's disabled that you are compelled to make choices and set priorities in providing services. I know that is not your choice. The money provided to you provides those limits.

What would be the total dollar needs to serve all of the 7 million that we can accept for discussion purposes as the universe figure?

Mr. KURZMAN. While they are getting up an estimate on that, Mr. Chairman, let me add that it just isn't the dollar amount that is involved as a constraint, and the other tremendously important national needs which obviously compete with funds for this very worthwhile program, but there is also the question of availability of trained personnel. This is something which also acts as a constraint and is not entirely a function of funding.

Senator CRANSTON. We do of course have priority problems to wrestle with in the Congress and in the executive branch. To make your response more realistic, I guess you should include a figure as to what it would cost to train the personnel necessary to carry on this work.

Perhaps you better provide that for the record and not try to improvise.

(The information referred to, subsequently supplied for the record, follows:)

What would be the total dollar amount needed to serve all your potential clients?

Recently available data from the 1970 census indicates a potential VR universe of 7 million persons. The total cost for services for this number is estimated to be $13 billion, computed as follows:

The larger number of disab'ed persons are those who wou'd have vocational potential and would receive all services necessary to prepare them for a gainful occupation. The smaller number would be assisted to improved living status at a lesser cost.

(Training information requested was not submitted.)

Senator CRANSTON. If all were served, and the 75 percent that you have been successful in getting rehabilitated to the point where they can undertake a vocation, what would be the total GNP increase and tax revenues generated?

I had better ask that for the record.

(The following was subsequently supplied for the record:)

If all were served, what would be the total GNP increase and tax revenue generated?

If all 7 to 11 million persons were served in FY 73, the rehabilitated among them will experience improvement in their earnings of about $6 billion to $9 billion in the first year after rehabilitation. This is their contribution to GNP in terms of increased earnings resulting from Vocational Rehabilitation Services. This is based on the comparison of what VR clients rehabilitated could have been earning at acceptance (estimated at $1.8 billion to $2.7 billion) without VR services with that of their earnings at closure (estimated at $7.8 billion to $11.7 billion) with VR scrvices.

The tax revenue generated by those persons rehabilitated out of the potential VR universe is estimated at $300 million to $450 million in the first year after rehabilitation. This is based on the increases in Federal taxes due to VR services of those persons rehabilitated.

Mr. KURZMAN. I should tell you that Secretary Richardson is extremely concerned about a problem which is pervasive among HEW programs, in which there is a tendency to believe that programs begun as demonstrations and experiments are in fact intended to reach the entire population of persons in like situations. He has asked for an intensive survey to be done of all HEW programs to determine precisely the kind of question you are asking.

What would it take to serve all people who are similarly situated to those who are receiving services under the programs on the books? A preliminary estimate that I have heard him give is it would take something like $100 billion, in addition to the current $78 billion HEW budget, to expand the services to include all those who are similarly situated to those who actually do receive services.

Mr. TWINAME. May I add that this is why we raised these concerns with you regarding title III.

As you know, we did not come up unalterably opposed to title III, but we thought the most responsible position we could take was to raise the serious concerns that you also allude to regarding a credibility gap. We can often engender disbelief among target groups and the general population by suggesting that we are going to solve the problem of some particular group by passing categorical programs that really can't cover a very large percentage of all those who would hope to be served and have great needs.

We raise that so that we can enter it into the dialog, and into the considerations of the subcommittee and the committee.

Senator CRANSTON. What do we know about the people who are left out, that are not served? Who are they? Are they pretty much the same as those people that are being served, and how is the choice made as to who gets served and who doesn't?

Mr. NEWMAN. The choice is made now on the basis of those who are brought to the attention of the State programs. So there may be people in fact, in the community, who are similarily handicapped who may not be fortunate enough to be found or to know about the benefits which this program can provide.

Mr. TWINAME. I think we ought to say that though we have come a long way from when we had people chained to the bedposts up in the attics to keep them out of the way, we still have in this country a very sad plight for many people who are out of the public view and out of mind, and, therefore, for whom the general public is indifferent.

So it is fair to say that there are many people suffering because of handicaps which are not getting to the rehabilitation program. The community isn't aware of them, and we really have a long fight ahead of us.

Senator CRANSTON. Are these people themselves or are the people responsible for them, not acting responsibly in their behalf, or are they not actually aware of the opportunities for help for them?

Mr. TWINAME. I think it is fair to say that we have, all the time, potential cases that are aware of the service possibilities. Then we come up with again the fact that we have limited resources overall for all the various programs that should be addressing the needs of handicapped people, and information certainly is one of these problems. Senator CRANSTON. How big an information program do you have?

Mr. TWINAME. We have one that is quite noteworthy in the Federal Government, I believe, using the Advertising Council of America. Last year they donated several millions of dollars worth of advertising through magazine and television. And we have had a campaign called "Hurrah, Help Us Reach and Rehabilitate America's Handicapped." This has been a most effective program of outreach, in that many people have written in and asked where can they get the services, and we referred many thousands of people from our Federal office to the State agency for followup. So I would think this is a good example of the kind of thing we hope to continue, and we would like to commend those in the business sector who have helped us in this special outreach program.

Senator CRANSTON. Do we have figures from the States on how many people come in hoping for help, apply for it, and cannot be helped simply because of your budgetary restrictions? Why don't you submit that for the record.

(The information referred to, subsequently supplied for the record, follows:)

Are there data from the States on how many people come in hoping for help, apply for it, and cannot be served simply because of budgetary restrictions? There is no current reporting requirement that would give such data. The reasons now recorded for closing a case at any point from referral on short of rehabilitation include such categories as: unable to locate or contact; or moved; handicap too severe or unfavorable prognosis; refused services or further services; death; client institutionalized; transferred to another agency; failure to cooperate; no disabling condition; no vocational handicap; other.

Some of these categories may actually be reflective of an extended delay in the provision of services caused by a lack of funds, which in turn causes lack of cooperation, relocation, or institutionalization.

RSA is currently working with the HEW Audit Agency to develop an audit instrument that will, among other things, attempt to determine the impact of lack of agency funds on cases closed not rehabilitated.1

1 A copy of this audit instrument is appended.