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TABLE3

REPORTONINFANTSANDTODDLERSEXITINGPARTC

2005-2006

PaperworkBurdenStatement

AccordingtothePaperworkReductionActof1995,nopersonsarerequiredtorespondtoacollectionofinformationunlessitdisplaysavalidOMBcontrolnumber. ThevalidOMBcontrolnumberforthisinformationcollectionis1820-0557. Thetimerequiredtocompletethisinformationcollectionisestimatedtoaverage45hoursperStateresponse,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.1418(a)(1)(A)(vi)and20U.S.C.1418(b)

DueDate:November1,2006

SamplingAllowed:Yes

SendFormto:Troy Justesen,Acting Director

Office of Special Education

Part C Data Reports

Program Support Services Group

Mail stop 2600

550 12th Street, S.W.

Washington, D.C.20202

Attn: Cheryl Broady

GeneralInstructions

1.InfantsandtoddlersreportedinthistableshouldbethosewhoexitedPartCservices(PartC)duringa12-monthreportingperiod.

2.Statesshouldreportcountsfora12-monthreportingperiod. TheStatecandeterminethe12-monthreportingperiodofdatacollection. Statesmustindicateontheformthe12-monthperiodusedforreporting.

  1. Reportonlychildrenfrombirththroughage2(uptotheirthirdbirthday)atthetimeofexiting.

  1. Reportallchildrenwhoreachedage3,eveniftheycontinuetoreceiveservicespaidforwithPartCfunds.
  1. Reportonlyoninfantsandtoddlersfrombirththroughage2attimeofexitwhohadanactiveindividualizedfamilyserviceplan(IFSP)inplaceatsomepointintimeduringthereportingperiod.

6.DonotcountachildashavingexitedPartCwhenservicesweretemporarilysuspended(i.e.,parenttemporarilyremovedthechildforaperiodoftimeduringwhichserviceswerenotreceived)andsubsequentlyresumedbeforetheendofthereportingperiod.

7.DonotcountachildashavingexitedPartCifthechildisunderage3andhadanactiveIFSPinplaceattheendofthereportingperiod,evenifserviceswereintermittentlystoppedduringthe12-monthperiod.

8.Countsmustbeunduplicated. Ifachildexitedmorethanonceduringthereportingperiod,andexitedagainattheendofthereportingperiod,countonlythelasttimethechildexited(i.e.,countthechildinthecategorythatcorrespondstothemostrecentreasonforexit).

9.AllchildrenwhoexitedPartCduringthereportingperiodshouldbecountedinoneofthecategoriesonthistable.

10.IfyourStatehaselectedtoservechildrenwhoareatriskofhavingsubstantialdevelopmentaldelaysifearlyinterventionserviceswerenotprovided,includethechildrenwhowereconsideredatriskinthetablecounts.

SpecificRowInstructions

Total: EnterthetotalnumberofinfantsandtoddlersexitingPartC.

SectionA:ProgramCompletion

1.CompletionofIFSPpriortoreachingmaximumageforPartC. IncludeallchildrenwhohavenotreachedmaximumageforPartC,havecompletedtheirIFSP,andnolongerrequireservicesunderIDEA,PartC.

2.EligibleforIDEA,PartB. IncludeallchildrenservedinPartCwhoexitedPartCandweredeterminedtobeeligibleforPartBduringthereportingperiod. ThisincludeschildrenwhoreceivePartBservicesinconjunctionwithHeadStart.

3.NoteligibleforPartB,exitwithreferralstootherprograms. IncludeallchildrenwhoreachedmaximumageforPartC,weredeterminednoteligibleforPartB,andwerereferredtootherprograms,whichmayincludepreschoollearningcenters,HeadStart(butnotreceivingPartBservices),andchildcarecenters,and/orwerereferredforotherservices,whichmayincludehealthandnutritionservices,suchasWIC.

4.NoteligibleforPartB,exitwithnoreferrals. IncludeallchildrenwhoreachedmaximumageforPartCandweredeterminednoteligibleforPartBservices,butwerenotreferredtootherprograms.

5.PartBeligibilitynotdetermined. IncludeallchildrenforwhomPartBeligibilityhasnotbeenmade. ThiscategoryincludeschildrenwhowerereferredforPartBevaluation,butforwhomtheeligibilitydeterminationhasnotyetbeenmadeorreportedandchildrenforwhomparentsdidnotconsenttotransitionplanning. IncludeinthiscategoryanychildwhoreachedmaximumageforPartC,andwhohasnotbeencountedincategories2-4above.

SectionB:OtherExitReasons

6.Deceased. Includeallchildrenwhodiedduringthereportingperiod,eveniftheirdeathoccurredattheageofexit.

7.MovedoutofState. IncludeallchildrenwhomovedoutofStateduringthereportingperiod. DonotreportachildwhomovedwithinState(i.e.,fromoneprogramtoanother)ifservicesareknowntobecontinuing.

8.Withdrawalbyparent(orguardian). IncludeallchildrenwhoseparentsdeclinedallservicesafteranIFSPwasinplace,aswellaschildrenwhoseparentsdeclinedtoconsenttoIFSPservicesandprovidedwrittenorverbalindicationofwithdrawalfromservices.

9.Attemptstocontacttheparentand/orchildwereunsuccessful. IncludeallchildrenwhohavenotreachedthemaximumageofserviceunderPartC,whohadanactiveIFSP,andforwhomPartCpersonnelhavebeenunabletocontactorlocatethefamilyorchildafterrepeated,documentedattempts. IncludeinthiscategoryanychildwhodidnotcompletetheirIFSPandexitedPartCbeforereachingmaximumage,andwhohasnotbeencountedincategories6-8above.

SpecificColumnInstructions(SectionsAandB)

Race/EthnicityReporting

STATESMUSTREPORTONTHERACE/ETHNICITYOFTHECHILD,NOTTHEFAMILY. FOREACHOFTHERACE/ETHNICITYCATEGORIES,ENTERANUNDUPLICATEDCOUNTOFALLCHILDRENSERVEDUNDERIDEA,PARTC.

In November 1997, OMB announced its decision concerning the revision of Race and Ethnic Standards for Federal Statistics and Administrative Reporting. In that announcement, OMB reported that there would be five racial categories -- American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, and White -- and one ethnic category -- Hispanic or Latino. Additionally, OMB announced that individuals would be allowed to select as many race/ethnicity categories as were applicable. Under the new reporting requirements a single, multi-racial category cannot be used. OSEP is actively working with other offices within the Department of Education (ED) to determine what categories will be used for reporting aggregated data 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.

Therace/ethnicitycategoriesaredefinedasfollows:

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

Notethatchildrencanonlybereportedinonerace/ethnicitycategory.

SamplingGuidelines

StatesmayusesamplingtoobtaindatafromStateandlocalserviceagenciesoncountsofinfantsandtoddlersexitingPartCprograms. Whensamplingisused,adescriptionofthesamplingmethodologyoutlininghowthedesignwillyieldvalidandreliableestimatesmustbesubmittedtoOSEPforapproval. Thelevelofprecisionoftheestimatestobeobtainedmustbespecifiedinthisdescription. StatesmustsubmitsamplingplanstoOSEPforapprovalbySeptember1ofthereportingperiod.

OSEPwillevaluatethevalidityofthesamplingplanusingthefollowingguidelines:

1.Thesamplingframeworkmayincludeallprogramsorserviceunitsorasampleofthoseprogramsorunits. IfaStatechoosestosample,programsorserviceunitsforthemostpopulousareasintheStatemustbeincluded.

2.Statesthatserveat-riskinfantsandtoddlersmustcollectdataseparatelyforeligibleinfantsandtoddlersandat-riskinfantsandtoddlers.

StatesthatusesamplingwillprovideOSEPwithweightedratherthanunweighteddata. Adescriptionofthefinalsamplesizesandtheweightsusedmustbeprovidedatthetimethedataaresubmitted.

U.S.DEPARTMENTOFEDUCATIONOMBNO.: 1820-0557

OFFICEOFSPECIALEDUCATION

ANDREHABILITATIVESERVICESFORMEXPIRES:8/31/2007

OFFICEOFSPECIALEDUCATIONTABLE3

PROGRAMS

REPORTONINFANTSANDTODDLERSEXITINGPARTCPROGRAMS

2005-2006

STATE:

12-MonthReportingPeriod(FromMM/YYtoMM/YY):______

REASONSFOREXIT / TOTAL / AMERICANINDIANORALASKANATIVE / ASIANORPACIFICISLANDER / BLACK(NotHispanic) / HISPANIC / WHITE(NotHispanic)
TOTALNUMBEROFINFANTSANDTODDLERSEXITING(ROWS1-9)
SECTIONA: PROGRAMCOMPLETION
1.COMPLETIONOFIFSPPRIORTOREACHINGMAXIMUMAGEFORPARTC
2.PARTBELIGIBLE
3.NOTELIGIBLEFORPARTB,EXITTOOTHERPROGRAMS
4.NOTELIGIBLEFORPARTB,EXITWITHNOREFERRALS
5.PARTBELIGIBILITYNOTDETERMINED
SECTIONB: OTHEREXITREASONS
6.DECEASED
7.MOVEDOUTOFSTATE
8.WITHDRAWALBYPARENT(ORGUARDIAN)
9.ATTEMPTSTOCONTACTUNSUCCESSFUL

ORIGINAL SUBMISSION/REVISION (Circle one)

CURRENT DATE: ______