Disabilitieseducationact,Asamended

Page 1of 4

TABLE1

REPORTOFCHILDRENWITHDISABILITIES

RECEIVINGSPECIALEDUCATION

UNDERPARTBOFTHEINDIVIDUALSWITH

DISABILITIESEDUCATIONACT,ASAMENDED

DECEMBER1,2005,ORTHELASTFRIDAYINOCTOBER2005

PaperworkBurdenStatement

AccordingtothePaperworkReductionActof1995,nopersonsarerequiredtorespondtoacollectionofinformationunlessitdisplaysavalidOMBcontrolnumber. ThevalidOMBcontrolnumberforthisinformationcollectionis1820-0043. Thetimerequiredtocompletethisinformationcollectionisestimatedtoaverage2hoursperLEAand9hoursperSEAresponse,includingthetimetoreviewinstructions,searchexistingdataresources,gatherthedataneeded,andcompleteandreviewtheinformationcollection. Ifyouhaveanycommentsconcerningtheaccuracyofthetimeestimate(s)orsuggestionsforimprovingthisform,pleasewriteto: U.S.DepartmentofEducation,Washington,D.C. 20202. Ifyouhavecommentsorconcernsregardingthestatusofyourindividualsubmissionofthisform,writedirectlyto: OfficeofSpecialEducationPrograms,U.S.DepartmentofEducation,400MarylandAvenue,SW,Washington,D.C. 20202.

Authorization:20U.S.C.1411(d)(2)and1418(a)(1)(A)(i)

DueDate:February1,2006

SamplingAllowed:SectionA-No

SectionB-Noforagegroup,yesfordiscreteagesandrace/ethnicity

SectionC-Noforagegroup,yesfordiscreteages

SectionD-Yes

SendFormto:Troy Justesen, ActingDirector

Office of Special Education

Part B Data Reports

Program Support Services Group

Mail stop 2600

550 12th Street, S.W.

Washington, D.C.20202

Attn: Cheryl Broady

GeneralInstructions

Countandreportallchildrenwithdisabilitiesreceivingspecialeducationandrelatedservicesaccordingtoanindividualizededucationprogramorserviceplan.[1] Thismustbeanunduplicatedcount(i.e.,eachchildwithadisabilityisrepresentedonlyonceonthisdatatableexceptinthetotals). Alltotalsmustrepresentthesumoftheprecedingrowsorcolumns. Wheredatacellscontainnonumericalvalue,placezeros(0).

2.ThecountistobetakenasofDecember1orthelastFridayofOctober. Childrenages3-5and
6-21mustbereportedaccordingtotheirdisabilitycategoryanddiscreteageyearbaseduponeachchild'sageasofthedatacollectiondate. Childrenwithmorethanonedisabilitycategorymustbereportedashavingmultipledisabilitiesordeaf-blindness,asappropriate. Childrenages3-5andages6-21shouldbereportedbytheirrace/ethnicityanddisabilitycategory.

3.Childrenages3through9maybereportedunderthecategorydevelopmentaldelayinthoseStatesinwhichdiagnosticinstrumentsandprocedureshavebeenputinplacetomeasuredelaysinoneormoreofthefollowingareas: physicaldevelopment,cognitivedevelopment,communicationdevelopment,socialoremotionaldevelopment,oradaptivedevelopment. Statesmusthavedefinedandestablishedeligibilitycriteriafordevelopmentaldelayinordertousethiscategoryforreporting.

4.Theuseofthecategory‘developmentaldelay’isoptional. NeitherStatesnorLEAsarerequiredtousethiscategory. StatesandLEAshavingdiagnosticinstrumentsandproceduresinplacetomeasuredelaysinoneormoreofthespecifiedareasmayreportthenumberofstudentshavingdevelopmentaldelaysattheirdiscretion. Ifthecategoryisused,itmustbereported.

5.Thereportingofdataonyouth22andolderisoptional.

6.WhileStatesmayusesamplingtoobtaindatafordiscreteagesandrace/ethnicitycategories,dataforagegroupingsmustbeactualcounts. Notethatthedataformindicateswhereactualcountsarerequired.

7.FormsmustbesubmittedtotheDepartmentofEducation,OfficeofSpecialEducationProgramsbyFebruary1.

SamplingGuidelines

Statesmayusesamplingtoobtaindatafordiscreteagesandrace/ethnicitycategories;however,dataforagegroupingsmustbeactualcounts. Statesmayalsosampletoprovidecountsofstudents22yearsoldandabove. Whensamplingisused,adescriptionofthesamplingmethodologyoutlininghowthedesignwillyieldvalidandreliableestimatesmustbesubmittedtoOSEPforapproval. Thelevelofprecisionoftheestimatestobeobtainedmustbespecifiedinthisdescription. StatesmustsubmitsamplingplanstoOSEPforapprovalbySeptember1ofthereportingyear(thatis,theSeptemberpriortothechildcount).

OSEPwillevaluatethevalidityofthesamplingplansusingtheguidelinesbelow.

1.Thesamplingframeworkmayincludeallschooldistrictsorasampleofdistricts. IfaStatechoosestosampledistricts,alldistrictswithaveragedailymemberships(ADM)ofover50,000mustbeincludedinthesample. Stateswithfewerthan25districtswithADMsover25,000mustincludealldistrictswithover25,000ADMs. Thetotalnumberofdistrictssampledmustequalorexceed100. IfthetotalnumberofdistrictsintheStateis100orfewer,datamustbecollectedfromalldistricts.

2.Whensamplingstudents,whetherforalldistrictsorforasampleofdistricts,datamustbecollectedseparatelyforeachFederaldisabilitycategory. Allstudentswhosedomicileisinadistrictmustbeeligibleforthesampleincludingthosestudentsservedincooperativesand/orintermediateunitsorinresidentialprogramsoutofthedistrict.

3.Aminimumsampleof100childrenmustbeusedbyalldistricts,exceptwherethetotalnumberinadisabilitycategoryislessthan100. Insuchacase,datamustbecollectedforallstudentsinthatcategory.

StatesthatusesamplingwillprovideOSEPwithweightedratherthanunweighteddata. Adescriptionofthefinalsamplesizesandtheweightsusedshouldalsobeprovidedatthetimethedataareprovided.

SpecificInstructions

SectionB

SectionBconsistsoftwosubsections. InsubsectionB-1,indicateforeachdiscreteageandtypeofdisabilitythenumberofchildrenreceivingspecialeducationandrelatedservicesaccordingtoanindividualizededucationprogram. Statesarerequiredtocompletetheentiretable,providingdatafordiscreteages,agegroupings,anddisabilitycategories. Statesmayusesamplingfordataondiscreteages,iftheStatedoesnotcollectdataforindividualages. SeethesectiononSamplingGuidelinesformoreinformation.

InsubsectionB-2,reportthetotalnumberofstudentswithdisabilitiesages3-5bydisabilityconditionandrace/ethnicitycategories. Statesmayusesamplingforrace/ethnicitycategories.

InNovember1997,OMBannounceditsdecisionconcerningtherevisionofRaceandEthnicStandardsforFederalStatisticsandAdministrativeReporting. Inthatannouncement,OMBreportedthattherewouldbefiveracialcategories--AmericanIndianorAlaskaNative,Asian,BlackorAfricanAmerican,NativeHawaiianorOtherPacificIslander,andWhite--andoneethniccategory--HispanicorLatino. Additionally,OMBannouncedthatindividualswouldbeallowedtoselectasmanyrace/ethnicitycategoriesaswereapplicable. Underthenewreportingrequirementsasingle,multi-racialcategorycannotbeused. OSEPisactivelyworkingwithotherofficeswithinthe Department of Education (ED)todeterminewhat categorieswill be used for reporting aggregateddata and anticipates that final decisions on reporting these data will be made soon. Until aggregate reporting categories are implemented, data should be reported using the five racial categories described below.

Enteranunduplicatednumberofallchildrenwithdisabilitiesages3-5byrace/ethnicitycategory. Therace/ethnicitycategoriesaredefinedasfollows:

AmericanIndianorAlaskaNative / ApersonhavingoriginsinanyoftheoriginalpeoplesofNorthandSouthAmerica(includingCentralAmerica)andwhomaintainstribalaffiliationorcommunityattachment.
AsianorPacificIslander / ApersonhavingoriginsinanyoftheoriginalpeoplesoftheFarEast,SoutheastAsia,theIndiansubcontinent,orthePacificIslands. Thisincludes,forexample,Cambodia,China,India,Japan,Korea,Malaysia,Pakistan,thePhilippineIslands,Thailand,Vietnam, Hawaii,Guam,andSamoa.
Black(notHispanic) / ApersonhavingoriginsinanyoftheBlackracialgroupsofAfrica.
Hispanic / ApersonofCuban,Mexican,PuertoRican,SouthorCentralAmerican,orotherSpanishcultureororigin,regardlessofrace.
White(notHispanic) / ApersonhavingoriginsinanyoftheoriginalpeoplesofEurope,theMiddleEast,orNorthAfrica.
Total / Theunduplicatedtotalacrosstherace/ethnicitydesignations.

Notethatchildrencanonlybereportedinonerace/ethnicitycategory.

Statesarerequiredtocompletetheentiretableprovidingdatafordiscreteages,agegroupings,andrace/ethnicitycategories. Statesthathavediscreteageand/orrace/ethnicitydataavailableshouldbasethereportonactual(notsample)data. Statesthatdonothavedataforeachdiscreteageorrace/ethnicitycategoriesarerequiredtoreportactualdatafortheagegrouping3-5andtousesamplingfordiscreteagesandrace/ethnicitycategories. SeethesectiononSamplingGuidelinesformoreinformation.

SectionC

Indicateforeachagecategoryandtypeofdisabilitythenumberofchildrenreceivingspecialeducationandrelatedservicesaccordingtoanindividualizededucationalprogram. Statesmayreportthenumberofchildrenexperiencingdevelopmentaldelay(s)ages6through9whoarereceivingspecialeducationandrelatedservices.

AsinSectionBabove,Statesarerequiredtocompletetheentiretableprovidingdatafordiscreteages,agegroupings,anddisabilitycategories. Statesthathavediscreteagesshouldbasethereportonactual(notsample)data. Statesthatdonothavedataforeachdiscreteagearerequiredtoreportactualdatafortheagegroupings6-21,andtousesamplingfordiscreteages. IfaStatehasactualdatafordiscreteages6through21andnotfor22andabove,theStatemaysampleforthe22andabovecategory. SeethesectiononSamplingGuidelinesformoreinformation.

SectionD

Reportthetotalnumberofstudentswithdisabilitiesages6-21bydisabilityconditionandrace/ethnicitycategories. Statesmayusesamplingforrace/ethnicitycategories. Usetherace/ethnicitycategoriesdefinedunderSectionB. Notethatstudentsmayonlybereportedinonerace/ethnicitycategory.

SectionE

ThisreportmustbesignedbytheChiefStateSchoolOfficerortheindividualauthorizedbytheStatetocertifythesecounts.

STATE:

SECTIONA

COUNTDATE: / MONTH / DAY / YEAR

ORIGINAL SUBMISSION/REVISION

CURRENT DATE: ______

STATE:______

SECTIONB

B-1. NUMBEROFCHILDRENAGES3-5RECEIVINGSPECIALEDUCATION
AGEASOFDATACOLLECTIONDATE
DISABILITY / 3 / 4 / 5 / 3-5
(ActualData)
MENTALRETARDATION
HEARINGIMPAIRMENTS
SPEECHORLANGUAGEIMPAIRMENTS
VISUALIMPAIRMENTS
EMOTIONALDISTURBANCE
ORTHOPEDICIMPAIRMENTS
OTHERHEALTHIMPAIRMENTS
SPECIFICLEARNINGDISABILITIES
DEAF-BLINDNESS
MULTIPLEDISABILITIES
AUTISM
TRAUMATICBRAININJURY
DEVELOPMENTALDELAY*
TOTAL: (Sumofalltheabove)

*Statesmusthavedefinedandestablishedeligibilitycriteriafordevelopmentaldelayinordertousethiscategoryforreporting.

EDFORM:869-5

ORIGINAL SUBMISSION/REVISION

CURRENT DATE: ______

U.S.DEPARTMENTOFEDUCATION
OFFICEOFSPECIALEDUCATION
ANDREHABILITATIVESERVICES
OFFICEOFSPECIALEDUCATION
PROGRAMS / TABLE1
REPORTOFCHILDRENWITHDISABILITIESRECEIVINGSPECIALEDUCATION
PARTB,INDIVIDUALSWITHDISABILITIESEDUCATIONACT,ASAMENDED / PAGE3OF8
OMBNO.:1820-0043
FORMEXPIRES: 8/31/2007
2005
STATE:
SECTIONB(Continued)
B-2. RACE/ETHNICITYOFCHILDRENAGES3-5RECEIVINGSPECIALEDUCATION
RACE/ETHNICITY
DISABILITY / AMERICANINDIANORALASKANATIVE / ASIANORPACIFICISLANDER / BLACK
(NOTHISPANIC) / HISPANIC / WHITE
(NOTHISPANIC) / TOTAL
MENTALRETARDATION
HEARINGIMPAIRMENTS
SPEECHORLANGUAGEIMPAIRMENTS
VISUALIMPAIRMENTS
EMOTIONALDISTURBANCE
ORTHOPEDICIMPAIRMENTS
OTHERHEALTHIMPAIRMENTS
SPECIFICLEARNINGDISABILITIES
DEAF-BLINDNESS
MULTIPLEDISABILITIES
AUTISM
TRAUMATICBRAININJURY
DEVELOPMENTALDELAY*
TOTAL: (Sumofalltheabove)

*Statesmusthavedefinedandestablishedeligibilitycriteriafordevelopmentaldelayinordertousethiscategoryforreporting.

EDFORM:869-5

ORIGINAL SUBMISSION/REVISION

CURRENT DATE: ______

STATE:______

SECTIONC

NUMBEROFCHILDRENAGES6-21RECEIVINGSPECIALEDUCATION
AGEASOFDATACOLLECTIONDATE
DISABILITY / 6 / 7 / 8 / 9 / 10 / 11
MENTALRETARDATION
HEARINGIMPAIRMENTS
SPEECHORLANGUAGEIMPAIRMENTS
VISUALIMPAIRMENTS
EMOTIONALDISTURBANCE
ORTHOPEDICIMPAIRMENTS
OTHERHEALTHIMPAIRMENTS
SPECIFICLEARNINGDISABILITIES
DEAF-BLINDNESS
MULTIPLEDISABILITIES
AUTISM
TRAUMATICBRAININJURY
DEVELOPMENTALDELAY*
TOTAL: (Sumofalltheabove)

*Statesmusthavedefinedandestablishedeligibilitycriteriafordevelopmentaldelayinordertousethiscategoryforreporting.

EDFORM:869-5

ORIGINAL SUBMISSION/REVISION

CURRENT DATE: ______

U.S.DEPARTMENTOFEDUCATION
OFFICEOFSPECIALEDUCATION
ANDREHABILITATIVESERVICES
OFFICEOFSPECIALEDUCATION
PROGRAMS / TABLE1
REPORTOFCHILDRENWITHDISABILITIESRECEIVINGSPECIALEDUCATION
PARTB,INDIVIDUALSWITHDISABILITIESEDUCATIONACT,ASAMENDED / PAGE5OF8
OMBNO.:1820-0043
FORMEXPIRES: 8/31/2007
2005
STATE:
SECTIONC(Continued)
NUMBEROFCHILDRENAGES6-21RECEIVINGSPECIALEDUCATION
AGEASOFDATACOLLECTIONDATE
DISABILITY / 12 / 13 / 14 / 15 / 16 / 17
MENTALRETARDATION
HEARINGIMPAIRMENTS
SPEECHORLANGUAGEIMPAIRMENTS
VISUALIMPAIRMENTS
EMOTIONALDISTURBANCE
ORTHOPEDICIMPAIRMENTS
OTHERHEALTHIMPAIRMENTS
SPECIFICLEARNINGDISABILITIES
DEAF-BLINDNESS
MULTIPLEDISABILITIES
AUTISM
TRAUMATICBRAININJURY
DEVELOPMENTALDELAY
TOTAL: (Sumofalltheabove)

EDFORM:869-5

ORIGINAL SUBMISSION/REVISION

CURRENT DATE: ______

U.S.DEPARTMENTOFEDUCATION
OFFICEOFSPECIALEDUCATION
ANDREHABILITATIVESERVICES
OFFICEOFSPECIALEDUCATION
PROGRAMS / TABLE1
REPORTOFCHILDRENWITHDISABILITIESRECEIVINGSPECIALEDUCATION
PARTB,INDIVIDUALSWITHDISABILITIESEDUCATIONACT,ASAMENDED / PAGE6OF8
OMBNO.:1820-0043
FORMEXPIRES: 8/31/2007
2005
STATE:
SECTIONC(Continued)
NUMBEROFCHILDRENAGES6-21RECEIVINGSPECIALEDUCATION
AGEASOFDATACOLLECTIONDATE
DISABILITY / 18 / 19 / 20 / 21 / 6-21
(ActualData) / 22+
(Optional) / 6-22+
(Optional)
MENTALRETARDATION
HEARINGIMPAIRMENTS
SPEECHORLANGUAGEIMPAIRMENTS
VISUALIMPAIRMENTS
EMOTIONALDISTURBANCE
ORTHOPEDICIMPAIRMENTS
OTHERHEALTHIMPAIRMENTS
SPECIFICLEARNINGDISABILITIES
DEAF-BLINDNESS
MULTIPLEDISABILITIES
AUTISM
TRAUMATICBRAININJURY
DEVELOPMENTALDELAY*
TOTAL: (Sumofalltheabove)

*Statesmusthavedefinedandestablishedeligibilitycriteriafordevelopmentaldelayinordertousethiscategoryforreporting.

EDFORM:869-5

ORIGINAL SUBMISSION/REVISION

CURRENT DATE: ______

U.S.DEPARTMENTOFEDUCATION
OFFICEOFSPECIALEDUCATION
ANDREHABILITATIVESERVICES
OFFICEOFSPECIALEDUCATION
PROGRAMS / TABLE1
REPORTOFCHILDRENWITHDISABILITIESRECEIVINGSPECIALEDUCATION
PARTB,INDIVIDUALSWITHDISABILITIESEDUCATIONACT,ASAMENDED / PAGE7OF8
OMBNO.:1820-0043
FORMEXPIRES: 8/31/2007
2005
STATE:
SECTIOND
RACE/ETHNICITYOFCHILDRENAGES6-21RECEIVINGSPECIALEDUCATION
RACE/ETHNICITY
DISABILITY / AMERICANINDIANORALASKANATIVE / ASIANORPACIFICISLANDER / BLACK
(NotHispanic) / HISPANIC / WHITE
(NOTHISPANIC) / TOTAL
MENTALRETARDATION
HEARINGIMPAIRMENTS
SPEECHORLANGUAGEIMPAIRMENTS
VISUALIMPAIRMENTS
EMOTIONALDISTURBANCE
ORTHOPEDICIMPAIRMENTS
OTHERHEALTHIMPAIRMENTS
SPECIFICLEARNINGDISABILITIES
DEAF-BLINDNESS
MULTIPLEDISABILITIES
AUTISM
TRAUMATICBRAININJURY
DEVELOPMENTALDELAY*
TOTAL: (Sumofalltheabove)

*Statesmusthavedefinedandestablishedeligibilitycriteriafordevelopmentaldelayinordertousethiscategoryforreporting.

EDFORM:869-5

ORIGINAL SUBMISSION/REVISION

CURRENT DATE: ______

STATE:

SECTIONE-CERTIFICATION

ICERTIFYthatthesedatarepresentanaccurateandunduplicatedcountofchildrenwithdisabilitiesreceivingspecialeducationandrelatedservicesoneitherDecember1orthelastFridayinOctober,accordingtoanIndividualizedEducationProgram.
AUTHORIZINGOFFICIAL
NAMEANDTITLE(TYPEORPRINT) / SIGNATURE / DATEOFSIGNATURE

Nofurthermoniesorotherbenefitsmaybepaidoutunderthisprogramunlessthisreportiscompletedandfiledasrequiredby20U.S.C.1418(a)(1)(A)(i);1402.

EDFORM:869-5

ORIGINAL SUBMISSION/REVISION

CURRENT DATE: ______

[1] Children enrolled in private school by a parent, but who are still receiving special education services through the LEA, may have a service plan rather than an IEP. These children should be included in the child count.