Reference: The SCSEP regulations, at 20 CFR Sections 641.309(b) and 641.311(b)(3); section 504 of the Rehabilitation Act of 1973; the Americans with Disabilities Act (ADA) of 1990; and their implementing regulations. Background: A number of questions have been generated by the May 17, 1995 SCSEP regulation regarding physical examinations and disabilities. Our experience since issuing the regulations indicates that additional information would be helpful. Moreover, it appears that many enrollees are no longer taking advantage of the physical examination program benefit. A common medical recommendation for people over the age of 50 is that they receive an annual physical exam. Physicals can identify serious medical problems. Recently, after physical exams, several enrollees at a project were found to have been exposed to tuberculosis. As a result of these exams, these people were able to get appropriate medical attention. The provision of free physical examinations has been a long-standing SCSEP program benefit that has been utilized by hundreds of thousands of SCSEP participants. Unfortunately, implementation of the 1995 regulations has resulted in fewer enrollees taking advantage of this benefit. Policy: Each SCSEP enrollee must be offered a physical exam upon entrance into the program, and at least annually thereafter. It is the policy of the Employment and Training Administration to actively promote this program benefit for each enrollee. Widespread failure by projects to encourage exams through non-coercive measures may be considered a program deficiency. Documentation of waivers by enrollees of their rights to physical exams are of considerably lesser importance than are records maintained by the project showing that the enrollees have had annual medical exams. Purpose of Physical Examinations: Examinations should not be arranged for the purpose of determining whether an enrollee is "fit to work." Concerns about the expenses of workers' compensation or other liability claims should not be a programmatic matter (although they clearly do constitute a managerial consideration). Physicals should be viewed as a benefit associated with SCSEP program participation; they can be useful in helping participants make informed judgements about their ability to perform certain work assignments, and in providing them with information on their general health. Arranging Physicals: Examinations need not be financed through the SCSEP. If enrollees have health insurance, including Medicare or Medicaid, and a preferred private physician, it is acceptable for annual physicals to be conducted in that manner. Some local projects arrange for physicals in conjunction with the local Public Health Service, which is also used as a host agency worksite. One national sponsor arranges medical examinations as part of the intake process; at the conclusion of the enrollment interview, the individual is told the time, date and place of the appointment. They are asked to keep that appointment unless it is necessary to reschedule. Action: SCSEP sponsors should review the attached Questions and Answers, and share copies with appropriate staff. It may be necessary for some sponsors to remind their staff and sub-projects of the importance of the medical exam. Appropriate staff and sub- projects should be advised of low-cost ways to arrange physical exams, e.g. working with the Public Health Service, free clinics, and other sources of medical examinations. If through their own efforts enrollees obtain medical exams or have just had one, this will meet the regulatory requirement. When monitoring local projects, sponsors are encouraged to review the proportion of enrollees who are receiving physical examinations arranged by the project. The attached information should answer many questions of project sponsors and result in greater enrollee use of the free medical examination program benefit.