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{"sheet":"Main","index":0,"n_rows":24,"n_cols":4,"rows_kept":24,"cut":false,"hidden":false,"merged":[]}
["訪問型職場適応援助者助成金"]
["支援対象障害者名簿（様式第９号）及び活動実績状況報告書（総括票）兼申請額計算書（様式第１０号）作成ツール"]
[]
[null,"１　事前準備"]
[null,"① 援助者リスト（Helpersシート）へ支援対象障害者情報の入力対象となる援助者番号、援助者氏名を事前に入力します。"]
[null,"　入力の際は援助者番号が重複しないようご注意ください。",null,"→　援助者リスト"]
[]
[null,"２　入力方法"]
[null,"① 右の「入力フォームを開く」ボタンをクリックします。"]
[null,"② 入力フォーム画面から支援対象者情報、基本情報、活動内容を入力していきます。"]
[null,"③ 途中で保存する場合は、「保存」ボタンをクリックします。"]
[null,"④ 入力済の支援対象障害者の方はこのMainシートで確認できます。"]
[]
[null,"３　出力方法"]
[null,"① 入力フォーム画面の「様式第9号 / 第10号　出力」ボタンをクリックします。"]
[null,"② 様式第９号及び様式第10号がまとめて出力されます。"]
[]
[null,"４　その他"]
[null,"① 作成に当たっては記入上の注意を必ずご確認ください。",null,"→　記入上の注意"]
[null,"② ファイル名は必要に応じて変更いただいて差し支えありません。"]
[null,"③ 詳しい説明書は機構ホームページ（この申請様式作成フォームをダウンロードいただいたページ）からご覧いただけます。"]
[]
[null,"入力済のデータ","0 件","※行をダブルクリックで編集"]
[null,"支援対象障害者番号","支給対象期","氏名"]

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["援助者番号","援助者氏名","→Mainシートへ"]
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[null,"援助者は20名まで入力可能です。"]

{"sheet":"記入上の注意","index":2,"n_rows":59,"n_cols":2,"rows_kept":59,"cut":false,"hidden":false,"merged":[]}
[]
[null,"【記入上の注意】"]
[null,"・　本様式は、支給対象期内に訪問型職場適応援助者による支援の計画（以下「支援計画」という。）に沿って支援を行った"]
[null,"　支援対象労働者ごとに作成してください。"]
[null,"　　本様式は「訪問型職場適応援助者助成金支給申請書」の別紙となりますので、必ず添付してください。"]
[null,"・　中高年齢等措置（中高措置）に係る支援かそうでないかを「中高措置」欄から選択してください。"]
[null,"・　「支援対象障害者番号」欄には、今期に申請する支援対象障害者について、連番を付してください。今期の支給申請に係る"]
[null,"　書類で「支援対象障害者番号」を記入することとされているところには、その番号を記入してください。"]
[null,"・　支援対象障害者の「勤務形態」、「雇入（予定）日」欄、「就労継続支援A型事業の利用者への該当の有無」欄については、"]
[null,"　支給申請の都度、支給対象期中の変更の有無を支援対象障害者を雇用する事業主に確認して記入してください。"]
[null,"　変更があったことを申請せずに助成金の受給を受けた場合は、返還等の対象となります。"]
[null,"・　「支援対象障害者雇用事業所」欄には、支援対象障害者を雇用する事業所に係る雇用保険適用事業所番号及び住所、電話番号"]
[null,"　名称、代表者氏名を記入してください。"]
[null,"・　「勤務先事業所」欄については、支援対象障害者が勤務する事業所が「支援対象障害者雇用事業所」欄と異なる場合に記入し"]
[null,"　てください。"]
[null,"・　「支援形態」欄は、該当する支援形態の番号に○を付けてください。（１もしくは２は必須。３、４については該当がある場合のみ選択）"]
[null,"　　４に○を付けた場合は、「別の支給申請に係る雇用保険適用事業所名」を記入してください。（別の支給申請に係る雇用保険適用事業所"]
[null,"　　の複数の訪問型職場適応援助者との「計画策定」や「地域センターが主催するケース会議」は４に含まれません。）"]
[null,"・　「支援等の内容／支援形態」欄は、支援等の内容及び支援形態を選択・記入してください。"]
[null,"　「支援計画策定」又は「ケース会議」に該当する支援については、訪問型職場適応援助者が行った支援について、２人まで助成対象"]
[null,"　となります。"]
[null,"　　支援形態の４を選択した場合、１回の助成金額を、支援を行った人数で除して支給するなどの調整を行います。"]
[null,"　この場合、これらの助成金額の確認のため、助成金の支給が遅れる可能性があります。また、支援形態の４が選択されていなかった"]
[null,"　にもかかわらず、後から同日の支援があったことが判明した場合、返還等の対象となります。"]
[null,"・　支援形態の４を選択した場合は「※１」欄に「別の支給申請に係る雇用保険適用事業所」であるaまたはbもしくはその両方の記号を"]
[null,"　記入すること。"]
[null,"・　「支援計画期間」欄には、添付する訪問型職場適応援助者支援計画書等の内容を転記してください。"]
[null,"・　「時間数」欄には、移動時間を含めて１回の支援時間を「①４時間以上（精神障害者の場合は３時間以上）」もしくは"]
[null,"　　「②４時間未満（精神障害者の場合は３時間未満）」かを選択し記載して下さい。"]
[]
[null,"・　今期活動内容欄については、下記にご留意の上、「支援等の内容」欄のいずれかの項目を○で囲んでください。"]
[null,"・「支援計画策定」とは、法人が自ら「訪問型職場適応援助者支援計画書」又は「訪問型職場適応援助者総合記録票」を策定した場合のほか、"]
[null,"　地域センターが作成する計画に関して訪問型職場適応援助者が計画策定に係る活動を実施する場合をいい、１人の対象障害者当たり以下の回数（４時間"]
[null,"　未満の支援の場合は１／２回として取扱います）までとします。"]
[null,"　　① 訪問型職場適応援助者が支援計画書を策定し、地域センターが承認する場合、４回（少なくとも１回は支援に係る事業所を訪問すること）"]
[null,"　　② 訪問型職場適応援助者がフォローアップ計画書を策定し、地域センターが承認する場合、１回"]
[null,"　　③ 地域センターが支援計画書を作成し、訪問型職場適応援助者が支援計画策定に係る活動をを行う場合、２回"]
[null,"　　　例：支援の実施に係る事業所の職場環境、本人の職務内容の把握又は従事予定の作業内容把握のための事業所訪問の実施"]
[null,"　　　　　訪問型職場適応援助者支援計画書（案）の作成　など"]
[null,"・「支援」とは、（独）高齢・障害・求職者雇用支援機構が作成又は承認した「訪問型職場適応援助者支援計画書」に基づく支援対象障害者、支援"]
[null,"　対象事業主及び家族に対する支援をいいます。"]
[null,"　　　例：支援対象障害者に対する挨拶・返事、報告・質問、会話への参加等のコミュニケーション能力の向上に係る支援"]
[null,"　　　　　事業主に対する障害特性の理解と障害に配慮した対応方法に係る助言・援助"]
[null,"　　　　　家族に対する障害特性と家族の対応の在り方、関係機関の利用方法に係る助言・援助　など"]
[null,"・「ケース会議」とは、地域センターが開催するケース会議をいいます。"]
[null,"・「フォローアップ」とは、「訪問型職場適応援助者総合記録票」に基づき実施される支援をいいます。精神障害者に係る通常のフォローアップ期間"]
[null,"　経過後の追加のフォローアップ期間の支援は3回までです。これを実施した場合は、「支援等の内容」の「フォローアップ」の横のカッコの中に"]
[null,"　何回目の支援であるか記入してください。"]
[]
[null,"・　「訪問先等名称」欄には支援等の内容を実施するために訪問した場所を記載してください。"]
[]
[null,"・　支援計画の回数より支援実施回数が超過する場合、支援実施日数超過理由書（様式第１８号（訪））の提出が必要となります。"]
[]
[null,"・　支援実施場所の如何を問わず、支援対象障害者が事務所を訪問したことに対応した等の計画によらない突発的な相談は、"]
[null,"　原則として助成金の対象となりませんのでご注意ください。"]
[null,"　　日程調整上の都合等の合理的な理由が認められる場合や支援対象事業主からの緊急の要請に対応した場合を除き、"]
[null,"　助成金が支給されなかったり、法人の受給資格認定が取り消される場合がありますので、ご注意ください。"]
[null,"　必要に応じて支援内容について、支援記録票による支援日誌の提出依頼や、支援対象事業主に対する聴取を行う場合が"]
[null,"　あります。"]

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[]
["身体障害",null,"あり",null,"あり",null,"あり",null,"1級",null,"①",null,"支援計画策定","✓",null,null,1,null,1,null,"a",null,"昭和"]
["知的障害",null,"なし",null,"なし",null,"なし",null,"2級",null,"②",null,"支援",null,null,null,2,null,2,null,"b",null,"平成"]
["精神障害",null,null,null,null,null,null,null,"3級",null,null,null,"ケース会議",null,null,null,3,null,3,null,"a,b"]
["精神障害（発達障害のみを有する場合を除く。）",null,null,null,null,null,null,null,"4級",null,null,null,"フォローアップ",null,"✓",null,null,null,4]
["発達障害",null,null,null,null,null,null,null,"5級",null,null,null,null,null,null,null,null,null,"1,3"]
["難病",null,null,null,null,null,null,null,"6級",null,null,null,null,null,null,null,null,null,"1,4"]
["高次脳機能障害",null,null,null,null,null,null,null,"重度",null,null,null,null,null,null,null,null,null,"2,3"]
[null,null,null,null,null,null,null,null,"重度以外",null,null,null,null,null,null,null,null,null,"2,4"]

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[null,null,null,null,null,null,"（ふりがな）\n支援対象障害者\n氏名\n（生年月日）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"障害の種類と等級",null,null,null,null,null,null,null,null,"中高措置",null,null,null,null,"雇用保険加入"]
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[null,null,null,null,null,null,"勤務先事業所\n（同上の場合\n記載不要）",null,null,null,null,"住所",null,null,null,"〒",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名称"]
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[null,null,null,null,null,null,"勤務形態",null,null,null,null,"(予定）週所定労働時間",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"時間／週",null,null,null,null,null,"雇入（予定）日"]
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[null,null,null,null,null,null,null,null,null,null,null,"　4　別の支給申請に係る雇用保険適用事業所の複数の訪問型職場適応援助者との同日支援",null,null,null,null,null,null,null,null,null,null,null,null,null,"別の支給申請に係る雇用保険適用事業所名　（※１）"]
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["移行支援期",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(",null,null,")",null,null,null,null,null,null,null,null,"(",null,")"]
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["フォローアップ期間",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(",null,null,")",null,null,null,null,null,null,null,null,"(",null,")"]
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["～",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(",null,null,")",null,null,null,null,null,null,null,null,"(",null,")"]
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["精神障害者の追加の",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(",null,null,")",null,null,null,null,null,null,null,null,"(",null,")"]
["フォローアップ期間"]
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["～",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(",null,null,")",null,null,null,null,null,null,null,null,"(",null,")"]
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[null,null,null,null,null,null,"支援回数計",null,null,null,null,null,null,null,null,"回"]
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[null,"　"]
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[null,"　"]
[null,"　　　　　"]
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["訪問型職場適応援助者別活動実績状況報告書(総括票）兼請求額計算書"]
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["職場適応援助者氏名\n本年度分として受理された認定申請書上の番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名"]
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["日付",null,null,null,"支援対象障害者氏名\n（支援対象障害者番号）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"時間数\n①／②",null,null,"中高措置",null,"※１",null,"支援対象障害者氏名\n（支援対象障害者番号）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"時間数\n①／②",null,null,"中高措置",null,"※１"]
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["①",null,null,null,"時間数のうち、\n1回の支援時間が4時間以上（精神障害者の場合は3時間以上）の支援",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"回",null,null,"×",null,null,null,"円","（中高措置）",null,null,null,null,null,null,null,"＝",null,null,null,null,null,null,"円"]
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["②",null,null,null,"時間数のうち、\n1回の支援時間が4時間未満（精神障害者の場合は3時間未満）の支援",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"回",null,null,"×",null,null,null,"円","（中高措置）",null,null,null,null,null,null,null,"＝",null,null,null,null,null,null,"円"]
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["③",null,null,null,"別の支給申請に係る雇用保険適用事業所の複数の訪問型職場適応援助者との同日支援（支援形態4）（※１）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"回",null,null,"×",null,null,null,"円","（中高措置）/2人",null,null,null,null,null,null,null,"＝",null,null,null,null,null,null,"円"]
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["支援等に係る助成額（中高年齢等措置）（①＋②＋③）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
["支援等に係る助成額（①＋②＋③）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
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["　",null,null,"【支給額】"]
[null,"障害の種別",null,null,null,null,null,null,null,null,null,null,"支援時間／番号",null,null,null,null,null,null,null,null,"支給額（１日あたり）"]
[null,"精神障害者",null,null,null,null,null,null,null,null,null,null,"３時間以上／①",null,null,null,null,null,null,null,null,"18,000円"]
[null,null,null,null,null,null,null,null,null,null,null,null,"３時間未満／②",null,null,null,null,null,null,null,null,"9,000円"]
[null,"精神障害者以外",null,null,null,null,null,null,null,null,null,null,"４時間以上／①",null,null,null,null,null,null,null,null,"18,000円"]
[null,null,null,null,null,null,null,null,null,null,null,null,"４時間未満／②",null,null,null,null,null,null,null,null,"9,000円"]
[null,"※１　ただし、１日の上限額は　３６，０００円となります。"]
[null,"※２　上限額を超えた日があった場合は、上限額を超えた支援（時系列で最後の支援）に係る支給額は"]
[null,"　　上限額までとなります。"]
[null,"※３　※２の場合は、上限額を超えた支援について①、②もしくは③のどちらかに、記載された式に関係なく"]
[null,"　　上限額までの支給額を記載してください。"]
[null,"※４　１日の上限額を超えた日に係る全ての支援については、支給申請の際に"]
[null,"　　「訪問型職場適応援助者支援記録票（様式11号）（訪）」の提出が必要となります。"]

{"sheet":"Template_Status","index":6,"n_rows":2,"n_cols":6,"rows_kept":2,"cut":false,"hidden":true,"merged":[]}
["支援実施状況"]
["職場適応援助者氏名","番号","A 支援等に係る助成額 \n(中高年齢等措置)\n（様式１０号の合計金額）","B 支援等に関わる助成額\n（様式１０号の合計金額）","C 支援等に関わる助成額計\n（A＋B）","D 実際の支給額計\n（１日の上限額を反映）"]

{"sheet":"Wk_Act","index":7,"n_rows":84,"n_cols":28,"rows_kept":84,"cut":false,"hidden":true,"merged":[]}
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[3,"20220702#003","202207#003","2022/07","2022-07-02","②",3,"若葉　明美","橋本県　友美","知的障害","その他","あり",null,9000,3,1,9000,9000,null,9000,9000,0,9000,36000,36000,0,9000,1]
[3,"20220705#003","202207#003","2022/07","2022-07-05","②",3,"若葉　明美","橋本県　友美","知的障害","その他","あり",null,9000,3,1,9000,9000,null,9000,9000,0,9000,36000,36000,0,9000,1]
[3,"20220710#003","202207#003","2022/07","2022-07-10","②",3,"若葉　明美","橋本県　友美","知的障害","その他","あり",null,9000,3,1,9000,9000,null,9000,9000,0,9000,36000,36000,0,9000,1]
[3,"20220725#003","202207#003","2022/07","2022-07-25","②",3,"若葉　明美","橋本県　友美","知的障害","その他","あり",null,9000,3,1,9000,9000,null,9000,9000,0,9000,36000,36000,0,9000,1]
[3,"20220802#003","202208#003","2022/08","2022-08-02","②",3,"若葉　明美","橋本県　友美","知的障害","その他","あり",null,9000,3,1,9000,9000,null,9000,9000,0,9000,72000,72000,0,9000,1]
[3,"20220805#003","202208#003","2022/08","2022-08-05","②",3,"若葉　明美","橋本県　友美","知的障害","その他","あり",null,9000,3,1,9000,9000,null,9000,9000,0,9000,72000,72000,0,9000,1]
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[3,"20220901#003","202209#003","2022/09","2022-09-01","②",3,"若葉　明美","橋本県　友美","知的障害","その他","あり",null,9000,3,1,9000,9000,null,9000,9000,0,9000,54000,45000,9000,9000,1]
[1,"20220903#003","202209#003","2022/09","2022-09-03","②",3,"若葉　明美","山形県　努","精神障害","その他","あり",null,9000,3,1,9000,9000,null,9000,9000,0,9000,54000,45000,9000,9000,1]
[2,"20220915#003","202209#003","2022/09","2022-09-15","②",3,"若葉　明美","井上村　葵","精神障害","その他","なし",null,9000,4,1,9000,null,9000,18000,9000,9000,18000,54000,45000,9000,18000,1]
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[3,"20221001#003","202210#003","2022/10","2022-10-01","②",3,"若葉　明美","橋本県　友美","知的障害","その他","あり",null,9000,3,1,9000,9000,null,9000,9000,0,9000,18000,18000,0,9000,1]
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[1,"20220520#004","202205#004","2022/05","2022-05-20","②",4,"幕張　剛志","山形県　努","精神障害","その他","あり",null,9000,3,1,9000,9000,null,9000,9000,0,9000,9000,9000,0,9000,1]
[2,"20220610#004","202206#004","2022/06","2022-06-10","②",4,"幕張　剛志","井上村　葵","精神障害","その他","なし",null,9000,4,1,9000,null,9000,9000,0,9000,9000,36000,18000,18000,9000,1]
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[2,"20220713#004","202207#004","2022/07","2022-07-13","②",4,"幕張　剛志","井上村　葵","精神障害","その他","なし",null,9000,4,1,9000,null,9000,9000,0,9000,9000,27000,18000,9000,9000,1]
[1,"20220718#004","202207#004","2022/07","2022-07-18","①",4,"幕張　剛志","山形県　努","精神障害","その他","あり",null,18000,1,1,18000,18000,null,18000,18000,0,18000,27000,18000,9000,18000,1]
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