Page 1 of 9

TABLE3

PARTB,INDIVIDUALSWITHDISABILITIESEDUCATIONACT

IMPLEMENTATIONOFFAPEREQUIREMENTS

DECEMBER1,2005,ORTHELASTFRIDAYINOCTOBER2005

PaperworkBurdenStatement

AccordingtothePaperworkReductionActof1995,nopersonsarerequiredtorespondtoacollectionofinformationunlessitdisplaysavalidOMBcontrolnumber. ThevalidOMBcontrolnumberforthisinformationcollectionis1820-0517. Thetimerequiredtocompletethisinformationcollectionisestimatedtoaverage24hoursperSEAand17hoursperLEAresponse,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),1418(a)(1)(A)(iii),1418(a)(1)(A)(iv),and1418(a)(2)

DueDate:February1,2006

SamplingAllowed:Yes

SendFormto:Troy Justesen,Acting Director

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

InSectionA,enteranunduplicatedcountofallchildrenwithdisabilitiesages3-5servedundertheIDEA,PartBprogram,bydiscreteageyearandeducationalenvironment. InSectionB,enteranunduplicatedcountofallchildrenwithdisabilitiesages3-5servedundertheIDEA,PartBprogram,byeducational

environmentanddisabilitycategory.[1] InSectionC,enteranunduplicatedcountofallchildrenwithdisabilitiesages6-21servedundertheIDEA,PartBprogram,byagecategoryandeducationalenvironment. Dataonchildrenages6-21mustbeprovidedbydisabilitycategory.1

Thistabledoesnotrequireaseparate,certifiedcountofchildren. However,itisintendedtoreflectthenumberofthechildrenreceivingservices,reportedbytheappropriateenvironmentcategory,onthedateofthechildcount. Stateshavetheoptionofusingoneoftwochildcountdates:thelastFridayinOctoberorDecember1. Statesmustusethesamedateforreportingplacementdatathatisusedinreportingthechildcountforthatyear.

ThecountsreportedinSectionsDandEmustbeincludedincountsofSectionAand B or SectionC.

Placezerosincategorieswherecellscontainnonumericvalues. Enter(-9)incategorieswheredataaremissing.

SamplingGuidelines

Statesmayusesamplingtoobtainthesedata. Whensamplingisused,adescriptionofthesamplingmethodology,includingastatementabouthowthedesignwillyieldvalidandreliableestimatesmustbesubmittedtoOSEPforapproval. Thelevelofprecisionoftheestimatestobeobtainedmustbespecified. StatesmustsubmitsamplingplanstoOSEPforapprovalbySeptember1ofthereportingschool year(thatis,theSeptemberpriortotheOctober or December childcount date).

OSEPwillevaluatethevalidityofthesamplingplansusingtheguidelinesbelow.

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

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

3.Aminimumsampleof100childrenmustbeusedbyalldistricts,exceptwherethetotalnumberinadisabilitycategoryislessthan100. Insuchacase,datamustbecollectedforallstudentsinthatcategory.

StatesthatusesamplingwillprovideOSEPwithweightedratherthanunweighteddata. Adescriptionofthefinalsamplesizesandtheweightsusedshouldalsobeprovidedatthetimethedataareprovided.

SpecificInstructions

SectionA:EducationalEnvironmentsofChildrenwithDisabilitiesAges3-5

ENTERANUNDUPLICATEDCOUNTOFALLCHILDRENWITHDISABILITIESAGES3-5SERVEDUNDERIDEA,PARTB,BYDISCRETEAGEYEARANDEDUCATIONALENVIRONMENT.

RowA.EarlyChildhoodSetting. UnduplicatedtotalwhoreceivedALL(100%)oftheirspecialeducationandrelatedservicesineducationalprogramsdesignedprimarilyforchildrenwithoutdisabilities. Nospecialeducationorrelatedservicesareprovidedinseparatespecialeducationsettings. Thismayinclude,butisnotlimitedtospecialeducationandrelatedservicesprovidedin:

  • regularkindergartenclasses;
  • publicorprivatepreschools;
  • HeadStartCenters;
  • childcarefacilities;
  • preschoolclassesofferedtoaneligiblepre-kindergartenpopulationbythepublicschoolsystem;
  • home/earlychildhoodcombinations;
  • home/HeadStartcombinations;and
  • othercombinationsofearlychildhoodsettings.

RowB.EarlyChildhoodSpecialEducationSetting. UnduplicatedtotalwhoreceivedALL(100%) oftheirspecialeducationandrelatedservicesineducationalprogramsdesignedprimarilyforchildrenwithdisabilitieshousedinregularschoolbuildingsorothercommunity-basedsettings. Nospecialeducationorrelatedservicesareprovidedinearlychildhoodor other settings.Thismayinclude,butisnotlimitedtospecialeducationandrelatedservicesprovidedin:

  • specialeducationclassroomsinregularschoolbuildings;
  • specialeducationclassroomsinchildcarefacilities,hospitalfacilitiesonanoutpatientbasis,orothercommunity-basedsettings;and
  • specialeducationclassroomsintrailersorportablesoutsideregularschoolbuildings.

RowC.Home. Unduplicatedtotalwhoreceivedall(100%) oftheirspecialeducationandrelatedservicesintheprincipalresidenceofthechild'sfamilyorcaregivers.

RowD.Part-TimeEarlyChildhood/Part-TimeEarlyChildhoodSpecialEducationSetting. Unduplicatedtotalwhoreceivedspecialeducationandrelatedservicesinmultiplesettings,includingspecialeducationandrelatedservicesareprovidedin: (1) thehome, (2)educationalprogramsdesignedprimarilyforchildrenwithoutdisabilities,(3)programsdesignedprimarilyforchildrenwithdisabilities, (4) residential facilities, and (5) separate schools. Thismayinclude,butisnotlimitedtospecialeducationandrelatedservicesprovidedin:

  • home/earlychildhoodspecialeducationcombinations;
  • HeadStart,childcare,nurseryschoolfacilities,orothercommunity-basedsettingsandoutsideoftheregularclasscombinations;
  • regularkindergartenclassesandoutsideoftheregularclasscombinations;
  • separateschool/earlychildhoodcombinations;and
  • residentialfacility/earlychildhoodcombinations.

RowE.ResidentialFacility. Unduplicatedtotalwhoreceivedall(100%) oftheirspecialeducationandrelatedservicesinpubliclyorprivatelyoperatedresidentialschoolsorresidentialmedicalfacilitiesonaninpatientbasis.

RowF.SeparateSchool. Unduplicatedtotalwhoreceivedall(100%) oftheirspecialeducationandrelatedservicesineducationalprogramsinpublicorprivatedayschoolsdesignedspecificallyforchildrenwithdisabilities.

RowG.ItinerantServiceOutsidetheHome(OPTIONAL). Unduplicatedtotalwhoreceivedall(100%) oftheirspecialeducationandrelatedservicesataschool,hospitalfacilityonanoutpatientbasis,orotherlocationforashortperiodoftime(i.e.,nomorethan3hoursperweek). (Thisrowdoesnotincludechildrenreceivingservicesathome;thosechildrenarereportedinrowC.) Theseservicesmaybeprovidedindividuallyortoasmallgroupofchildren. Thismayinclude,butisnotlimitedto: speechinstructionupto3hoursperweekinaschool,hospital,orothercommunity-basedsetting. Childrenreceivingalloftheirspecialeducationandrelatedservicesataschool,hospitalfacilityonanoutpatientbasis,orotherlocationforlongerthan3hoursmustbereportedunderearlychildhoodspecialeducationsettingorearlychildhoodsetting,dependingonwhethertheprogramwasdesignedprimarilyforstudentswithorwithoutdisabilities.

RowH.ReverseMainstreamSetting(OPTIONAL). Unduplicatedtotalwhoreceivedall(100%) oftheirspecialeducationandrelatedservicesineducationalprogramsdesignedprimarilyforchildrenwithdisabilitiesbutthatinclude50percentormorechildrenwithoutdisabilities.

RowI.Total. ThesumofrowsAthroughH.

Theorderofthecategoriesforpreschoolersages3-5doesnotreflectacontinuumfromleasttomostrestrictive. Thecategoriesarealphabetical,withoptionalcategorieslistedlast.

SectionB: EducationEnvironmentsofChildrenwithDisabilitiesAges3-5byDisability

ENTERANUNDUPLICATEDCOUNTOFALLCHILDRENWITHDISABILITIESAGES3-5SERVEDUNDERIDEA,PARTB,BYEDUCATIONALENVIRONMENTANDDISABILITYCATEGORY. ThecategoriesreportedinthissectionmustsumtothetotalreportedinSectionA.

UsetheenvironmentcategoriesdefinedunderSectionA.

SectionC: EducationalEnvironmentsofChildrenwithDisabilitiesAges6-21

ENTERANUNDUPLICATEDCOUNTOFALLCHILDRENWITHDISABILITIESAGES6-21SERVEDUNDERTHEIDEA,PARTBPROGRAM,BYAGECATEGORYANDEDUCATIONALENVIRONMENT. THETOTALLINEONEACHTABLEMUSTEQUALTHESUMOFTHEDISABILITYCATEGORIES.

Allcountsshouldrepresentthesettinginwhichchildrenwithdisabilitieshavebeenplacedforeducationalservices.

Tocalculatethepercentageoftimeoutsidetheregularclassroom,dividethenumberofhourstheyouthreceivesspecialeducationandrelatedservicesoutsidetheregularclassroombythetotalnumberofhoursintheschoolday(including lunch, recess and study periods).

Home-schooledstudentswhoreceivespecialeducationandrelatedservicesprovidedbythelocaleducationalagencyshouldbecountedincolumnsA,B,orC. Forthesestudents,thenumberofhoursoutsidetheregularclassroomisthenumberofhourstheyouthspendsinseparatespecialeducationenvironments(e.g.resourcerooms,self-containedspecialeducationclassrooms,separateschools).

Educationaltimespentinage-appropriatecommunity-basedsettingsthatincludeindividualswithandwithoutdisabilities,suchascollegecampusesorvocationalsites,shouldbecountedastimespentwithnon-disabledpeers.

ColumnA.Specialeducationoutsideregularclasslessthan21percentofday. Unduplicatednumberofchildrenwithdisabilitiesreceivingspecialeducationandrelatedservicesoutsidetheregularclassroomforlessthan21percentoftheschoolday. Thismayincludechildrenwithdisabilitiesplacedin:

  • regularclasswithspecialeducation/relatedservicesprovidedwithinregularclasses;
  • regularclasswithspecialeducation/relatedservicesprovidedoutsideregularclasses;or
  • regularclasswithspecialeducationservicesprovidedinresourcerooms.

ColumnB.Specialeducationoutsideregularclassatleast21percentofdayandnomorethan60percentofday. Unduplicatedtotalincludeschildrenwithdisabilitiesreceivingspecialeducationandrelatedservicesoutsidetheregularclassroomforatleast21percentbutnomorethan60percentoftheschoolday. Do not include children who are reported as receiving education programs in public or private separate school or residential facilities. Thismayincludechildrenplacedin:

  • resourceroomswithspecialeducation/relatedservicesprovidedwithintheresourceroom;or
  • resourceroomswithpart-timeinstructioninaregularclass.

ColumnC.Specialeducationoutsideregularclassmorethan60percentofday. Unduplicatedtotalincludeschildrenwithdisabilitiesreceivingspecialeducationandrelatedservicesoutsidetheregularclassroomformorethan60percentoftheschoolday. Donotincludechildrenwhoare reported as receivingeducationprogramsinpublicorprivateseparateschool orresidentialfacilities.Thiscategorymayincludechildrenplacedin:

  • self-containedspecialclassroomswithpart-timeinstructioninaregularclass;or
  • self-containedspecialclassroomswithfull-timespecialeducationinstructiononaregularschoolcampus.

ColumnD.Publicseparateschool. Unduplicatedtotalwhoreceivededucationprogramsinpublicseparatedayschoolfacilities. Thisincludeschildrenwithdisabilitiesreceivingspecialeducationandrelatedservicesforgreaterthan50percentoftheschooldayinpublicseparateschools. Thismayincludechildrenplacedin:

  • publicdayschoolsforstudentswithdisabilities;
  • publicdayschoolsforstudentswithdisabilitiesforaportionoftheschoolday(greaterthan50percent)andinregularschoolbuildingsfortheremainderoftheschoolday;or
  • publicresidentialfacilitiesifthestudentdoesnotliveatthefacility.

ColumnE.Privateseparateschool. Unduplicatedtotalwhoreceivededucationprogramsinprivateseparatedayschoolfacilities. Thisincludeschildrenwithdisabilitiesreceivingspecialeducationandrelatedservices,atpublicexpense,forgreaterthan50percentoftheschooldayinprivateseparateschools. Thismayincludechildrenplacedin:

  • privatedayschoolsforstudentswithdisabilities;
  • privatedayschoolsforstudentswithdisabilitiesforaportionoftheschoolday(greaterthan50percent)andinregularschoolbuildingsfortheremainderoftheschoolday;or
  • privateresidentialfacilitiesifthestudentdoesnotliveatthefacility.

ColumnF.Publicresidentialfacility. Unduplicatedtotalwhoreceivededucationprogramsandlivedinpublicresidentialfacilitiesduringtheschoolweek. Thisincludeschildrenwithdisabilitiesreceivingspecialeducationandrelatedservicesforgreaterthan50percentoftheschooldayinpublicresidentialfacilities.Thismayincludechildrenplacedin:

  • publicresidentialschoolsforstudentswithdisabilities;or
  • publicresidentialschoolsforstudentswithdisabilitiesforaportionoftheschoolday(greaterthan50percent)andinseparatedayschoolsorregularschoolbuildingsfortheremainderoftheschoolday.

Donotincludestudentswhoreceivededucationprogramsatthefacility,butdonotlivethere.

ColumnG.Privateresidentialfacility. Unduplicatedtotalwhoreceivededucationprogramsandlivedinprivateresidentialfacilitiesduringtheschoolweek. Thisincludeschildrenwithdisabilitiesreceivingspecialeducationandrelatedservices,atpublicexpense,forgreaterthan50percentoftheschooldayinprivateresidentialfacilities. Thismayincludechildrenplacedin:

  • privateresidentialschoolsforstudentswithdisabilities;or
  • privateresidentialschoolsforstudentswithdisabilitiesforaportionoftheschoolday(greaterthan50percent)andinseparatedayschoolsorregularschoolbuildingsfortheremainderoftheschoolday.

Donotincludestudentswhoreceivededucationprogramsatthefacility,butdonotlivethere.

ColumnH.Homebound/Hospital. Unduplicatedtotalwhoreceivededucationprogramsinhomebound/hospitalenvironmentincludeschildrenwithdisabilitiesplacedinandreceivingspecialeducationandrelatedservicesin:

  • hospitalprograms,or
  • homeboundprograms.

Donotincludechildrenwithdisabilitieswhoseparentshaveoptedtohome-schoolthemandwhoreceivespecialeducationatthepublicexpense.

SectionD: DuplicativeCountofChildrenwithDisabilitiesServedinCorrectionalFacilities

IndicateforeachtypeofdisabilitycategorythenumberofchildrenreportedinSectionsAandCwhoarereceivingspecialeducationincorrectionalfacilities. DATAREPORTEDINSECTIONCAREADUPLICATEDCOUNTOFSECTIONSAANDC. Thesedataareintendedtobeacountofallchildrenreceivingspecialeducationin:

  • short-termdetentionfacilities(community-basedorresidential),or
  • correctionalfacilities.

SectionE: DuplicativeCountofChildrenwithDisabilitiesEnrolledinPrivateSchoolsNotPlacedorReferredbyPublicAgencies

ENTERTHETOTALNUMBEROFCHILDRENWITHDISABILITIESREPORTEDINSECTIONAANDCwhohavebeenenrolledbytheirparentsorguardiansinregularparochialorotherprivateschoolsandwhosebasiceducationispaidthroughprivateresourcesandwhoreceivespecialeducationandrelatedservicesatpublicexpensefromalocaleducationalagencyorintermediateeducationalunitunderaserviceplan.[2] (See34CFR300.452.)

SectionsFandG: Race/EthnicityofChildrenwithDisabilitiesServedunderIDEA,PartB

ENTERANUNDUPLICATEDCOUNTOFALLCHILDRENWITHDISABILITIESSERVEDUNDERIDEA,PARTBBYRACE/ETHNICITYANDEDUCATIONALENVIRONMENT. THETOTALDATAREPORTEDONEACHLINEINSECTIONFMUSTEQUALTHETOTALDATAREPORTEDINTHECORRESPONDINGEDUCATIONALENVIRONMENTINSECTIONA,ANDTHETOTALDATAREPORTEDONEACHLINEINSECTIONGMUSTEQUALTHETOTALDATAREPORTEDINTHECORRESPONDINGEDUCATIONALENVIRONMENTINSECTIONC.

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.

SectionH: DuplicativeCountoftheRace/EthnicityofChildrenwithDisabilitiesServedunderIDEA,PartBinCorrectionalFacilitiesandParent-InitiatedPrivateSchools

ENTERTHERACE/ETHNICITYDATAFORSTUDENTSREPORTEDINSECTIONSDANDE.

Usetherace/ethnicitycategoriesdefinedunderSectionsFandG. Notethatchildrencanonlybereportedinonerace/ethnicitycategory.

U.S.DEPARTMENTOFEDUCATIONPAGE1OF10

OFFICEOFSPECIALEDUCATIONTABLE3

ANDREHABILITATIVESERVICESOMBNO.: 1820-0517

OFFICEOFSPECIALEDUCATIONPARTB,INDIVIDUALSWITHDISABILITIESEDUCATIONACT

PROGRAMSIMPLEMENTATIONOFFAPEREQUIREMENTSFORMEXPIRES:8/31/2007

2005

STATE:______

SECTIONA: EDUCATIONALENVIRONMENTOFCHILDRENWITHDISABILITIESAGES3-5

EDUCATIONALENVIRONMENT: / AGE
3 / 4 / 5 / Total
(A)EARLYCHILDHOODSETTING
(B)EARLYCHILDHOODSPECIALEDUCATIONSETTING
(C)HOME
(D)PARTTIMEEARLYCHILDHOOD/PARTTIMEEARLYCHILDHOODSPECIAL
EDUCATIONSETTING
(E)RESIDENTIALFACILITY
(F)SEPARATESCHOOL
(G)ITINERANTSERVICEOUTSIDETHEHOME(OPTIONAL)
(H)REVERSEMAINSTREAMSETTING(OPTIONAL)
(I)TOTAL

EDFORM:869-4

Theorderofthecategoriesdoesnotreflectacontinuumfromleasttomostrestrictive. Thecategoriesarealphabetized,withtheexceptionofthetwooptionalcategories,whicharelistedattheend.

U.S.DEPARTMENTOFEDUCATIONPAGE2OF10

OFFICEOFSPECIALEDUCATIONTABLE3(continued)

ANDREHABILITATIVESERVICESOMBNO.: 1820-0517

OFFICEOFSPECIALEDUCATIONPARTB,INDIVIDUALSWITHDISABILITIESEDUCATIONACT

PROGRAMSIMPLEMENTATIONOFFAPEREQUIREMENTSFORMEXPIRES: 8/31/2007

2005

STATE:______

SECTIONB: EDUCATIONALENVIRONMENTOFCHILDRENWITHDISABILITIESAGES3-5

EDUCATIONALENVIRONMENT: /
(A)
EARLYCHILDHOOD
SETTING /
(B)
EARLYCHILDHOODSPECIALEDUCATIONSETTING /
(C)
HOME / (D)
PART-TIMEEARLYCHILDHOOD/PART-TIMEEARLYCHILDHOODSPECIALEDUCATIONSETTINGS
DISABILITY / AGES3-5
MENTALRETARDATION
HEARINGIMPAIRMENTS
SPEECHORLANGUAGEIMPAIRMENTS
VISUALIMPAIRMENTS
EMOTIONALDISTURBANCE
ORTHOPEDICIMPAIRMENTS
OTHERHEALTHIMPAIRMENTS
SPECIFICLEARNINGDISABILITIES
DEAF-BLINDNESS
MULTIPLEDISABILITIES
AUTISM
TRAUMATICBRAININJURY
DEVELOPMENTALDELAY*
TOTAL:

EDFORM:869-4

*Statesmusthavedefinedandestablishedeligibilitycriteriafordevelopmentaldelayinordertousethiscategoryforreporting.

U.S.DEPARTMENTOFEDUCATIONPAGE3OF10

OFFICEOFSPECIALEDUCATIONTABLE3(continued)

ANDREHABILITATIVESERVICESOMBNO.: 1820-0517

OFFICEOFSPECIALEDUCATIONPARTB,INDIVIDUALSWITHDISABILITIESEDUCATIONACT

PROGRAMSIMPLEMENTATIONOFFAPEREQUIREMENTSFORMEXPIRES: 8/31/2007

2005

STATE:______

SECTIONB(continued)

EDUCATIONALENVIRONMENT: /
(E)
RESIDENTIALFACILITY /
(F)
SEPARATESCHOOL / (G)
ITINERANTSERVICEOUTSIDETHEHOME(OPTIONAL) /
(H)
REVERSEMAINSTREAMSETTING(OPTIONAL)
DISABILITY / AGES3-5
MENTALRETARDATION
HEARINGIMPAIRMENTS
SPEECHORLANGUAGEIMPAIRMENTS
VISUALIMPAIRMENTS
EMOTIONALDISTURBANCE
ORTHOPEDICIMPAIRMENTS
OTHERHEALTHIMPAIRMENTS
SPECIFICLEARNINGDISABILITIES
DEAF-BLINDNESS
MULTIPLEDISABILITIES
AUTISM
TRAUMATICBRAININJURY
DEVELOPMENTALDELAY*
TOTAL:

EDFORM:869-4

*Statesmusthavedefinedandestablishedeligibilitycriteriafordevelopmentaldelayinordertousethiscategoryforreporting.

U.S.DEPARTMENTOFEDUCATIONPAGE4OF10

OFFICEOFSPECIALEDUCATIONTABLE3(continued)

ANDREHABILITATIVESERVICESOMBNO.: 1820-0517

OFFICEOFSPECIALEDUCATIONPARTB,INDIVIDUALSWITHDISABILITIESEDUCATIONACT

PROGRAMSIMPLEMENTATIONOFFAPEREQUIREMENTSFORMEXPIRES: 8/31/2007

2005

STATE:______

SECTIONC: EDUCATIONALENVIRONMENTOFCHILDRENWITHDISABILITIESAGES6-21

EDUCATIONALENVIRONMENT: / (A)
CHILDRENWHORECEIVED
SPECIALEDUCATIONOUTSIDETHEREGULARCLASSLESSTHAN21PERCENTOFDAYBYAGECATEGORY / (B)
CHILDRENWHORECEIVED
SPECIALEDUCATIONOUTSIDETHEREGULARCLASSATLEAST21PERCENTOFDAYBUTNOMORETHAN60PERCENTOFDAYBYAGECATEGORY
DISABILITY / (1)
6-11 / (2)
12-17 / (3)
18-21 / (4)
6-11 / (5)
12-17 / (6)
18-21
MENTALRETARDATION
HEARINGIMPAIRMENTS
SPEECHORLANGUAGEIMPAIRMENTS
VISUALIMPAIRMENTS
EMOTIONALDISTURBANCE
ORTHOPEDICIMPAIRMENTS
OTHERHEALTHIMPAIRMENTS
SPECIFICLEARNINGDISABILITIES
DEAF-BLINDNESS
MULTIPLEDISABILITIES
AUTISM
TRAUMATICBRAININJURY
DEVELOPMENTALDELAY*
TOTAL:

ED FORM: 869-4

*Statesmusthavedefinedandestablishedeligibilitycriteriafordevelopmentaldelayinordertousethiscategoryforreporting.

U.S.DEPARTMENTOFEDUCATIONPAGE5OF10

OFFICEOFSPECIALEDUCATIONTABLE3(continued)

ANDREHABILITATIVESERVICESOMBNO.: 1820-0517

OFFICEOFSPECIALEDUCATIONPARTB,INDIVIDUALSWITHDISABILITIESEDUCATIONACT

PROGRAMSIMPLEMENTATIONOFFAPEREQUIREMENTSFORMEXPIRES: 8/31/2007

2005

STATE:______

SECTIONC(continued)

EDUCATIONALENVIRONMENT: / (C)
CHILDRENWHORECEIVED
SPECIALEDUCATIONOUTSIDEREGULARCLASSFORMORETHAN60PERCENTOFDAYBYAGECATEGORY / (D)
CHILDRENWHORECEIVED
SPECIALEDUCATIONINPUBLIC
SEPARATESCHOOLBYAGECATEGORY
DISABILITY / (7)
6-11 / (8)
12-17 / (9)
18-21 / (10)
6-11 / (11)
12-17 / (12)
18-21
MENTALRETARDATION
HEARINGIMPAIRMENTS
SPEECHORLANGUAGEIMPAIRMENTS
VISUALIMPAIRMENTS
EMOTIONALDISTURBANCE
ORTHOPEDICIMPAIRMENTS
OTHERHEALTHIMPAIRMENTS
SPECIFICLEARNINGDISABILITIES
DEAF-BLINDNESS
MULTIPLEDISABILITIES
AUTISM
TRAUMATICBRAININJURY
DEVELOPMENTALDELAY*
TOTAL:

ED FORM: 869-4

*Statesmusthavedefinedandestablishedeligibilitycriteriafordevelopmentaldelayinordertousethiscategoryforreporting.

U.S.DEPARTMENTOFEDUCATIONPAGE6OF10

OFFICEOFSPECIALEDUCATIONTABLE3(continued)

ANDREHABILITATIVESERVICESOMBNO.: 1820-0517

OFFICEOFSPECIALEDUCATIONPARTB,INDIVIDUALSWITHDISABILITIESEDUCATIONACT

PROGRAMSIMPLEMENTATIONOFFAPEREQUIREMENTSFORMEXPIRES: 8/31/2007

2005

STATE:______

SECTIONC(continued)

EDUCATIONALENVIRONMENT: / (E)
CHILDRENWHORECEIVED
SPECIALEDUCATIONINPRIVATE
SEPARATESCHOOLBYAGECATEGORY / (F)
CHILDRENWHORECEIVED
SPECIALEDUCATIONINPUBLIC
RESIDENTIALFACILITYBYAGECATEGORY
DISABILITY / (13)
6-11 / (14)
12-17 / (15)
18-21 / (16)
6-11 / (17)
12-17 / (18)
18-21
MENTALRETARDATION
HEARINGIMPAIRMENTS
SPEECHORLANGUAGEIMPAIRMENTS
VISUALIMPAIRMENTS
EMOTIONALDISTURBANCE
ORTHOPEDICIMPAIRMENTS
OTHERHEALTHIMPAIRMENTS
SPECIFICLEARNINGDISABILITIES
DEAF-BLINDNESS
MULTIPLEDISABILITIES
AUTISM
TRAUMATICBRAININJURY
DEVELOPMENTALDELAY*
TOTAL:

ED FORM: 869-4

*Statesmusthavedefinedandestablishedeligibilitycriteriafordevelopmentaldelayinordertousethiscategoryforreporting.

U.S.DEPARTMENTOFEDUCATIONPAGE7OF10

OFFICEOFSPECIALEDUCATIONTABLE3(continued)

ANDREHABILITATIVESERVICESOMBNO.: 1820-0517

OFFICEOFSPECIALEDUCATIONPARTB,INDIVIDUALSWITHDISABILITIESEDUCATIONACT

PROGRAMSIMPLEMENTATIONOFFAPEREQUIREMENTSFORMEXPIRES: 8/31/2007

2005

STATE:______

SECTIONC(continued)

EDUCATIONALENVIRONMENT: / (G)
CHILDRENWHORECEIVED
SPECIALEDUCATIONINPRIVATE
RESIDENTIALFACILITYBYAGECATEGORY / (H)
CHILDRENWHORECEIVED
SPECIALEDUCATIONINHOMEBOUND/HOSPITAL
PLACEMENTBYAGECATEGORY
DISABILITY / (19)
6-11 / (20)
12-17 / (21)
18-21 / (22)
6-11 / (23)
12-17 / (24)
18-21
MENTALRETARDATION
HEARINGIMPAIRMENTS
SPEECHORLANGUAGEIMPAIRMENTS
VISUALIMPAIRMENTS
EMOTIONALDISTURBANCE
ORTHOPEDICIMPAIRMENTS
OTHERHEALTHIMPAIRMENTS
SPECIFICLEARNINGDISABILITIES
DEAF-BLINDNESS
MULTIPLEDISABILITIES
AUTISM
TRAUMATICBRAININJURY
DEVELOPMENTALDELAY*
TOTAL:

ED FORM: 869-4

*Statesmusthavedefinedandestablishedeligibilitycriteriafordevelopmentaldelayinordertousethiscategoryforreporting.

U.S.DEPARTMENTOFEDUCATIONPAGE8OF10

OFFICEOFSPECIALEDUCATIONTABLE3(continued)

ANDREHABILITATIVESERVICESOMBNO.: 1820-0517

OFFICEOFSPECIALEDUCATIONPARTB,INDIVIDUALSWITHDISABILITIESEDUCATIONACT

PROGRAMSIMPLEMENTATIONOFFAPEREQUIREMENTSFORMEXPIRES: 8/31/2007

2005

STATE:______

SECTIOND:DUPLICATEDCOUNTOFCHILDRENWITHDISABILITIESSERVEDINCORRECTIONALFACILITIES / SECTIONE:DUPLICATEDCOUNTOFCHILDRENWITHDISABILITIESENROLLEDINPRIVATESCHOOLSNOTPLACEDORREFERREDBYPUBLICAGENCIES
EDUCATIONALENVIRONMENT: / CHILDRENWHO
RECEIVEDSPECIALEDUCATION
INCORRECTIONALFACILITIES / CHILDRENWITHDISABILITIESENROLLEDINPRIVATESCHOOLSNOTPLACEDORREFERREDBYPUBLICAGENCIES
DISABILITY / THROUGHAGE21 / AGES3-21
MENTALRETARDATION / TOTAL
HEARINGIMPAIRMENTS
SPEECHORLANGUAGEIMPAIRMENTS
VISUALIMPAIRMENTS
EMOTIONALDISTURBANCE
ORTHOPEDICIMPAIRMENTS
OTHERHEALTHIMPAIRMENTS
SPECIFICLEARNINGDISABILITIES
DEAF-BLINDNESS
MULTIPLEDISABILITIES
AUTISM
TRAUMATICBRAININJURY
DEVELOPMENTALDELAY*
TOTAL:

ED FORM: 869-4

*Statesmusthavedefinedandestablishedeligibilitycriteriafordevelopmentaldelayinordertousethiscategoryforreporting.

U.S.DEPARTMENTOFEDUCATIONPAGE9OF10

OFFICEOFSPECIALEDUCATIONTABLE3(continued)

ANDREHABILITATIVESERVICESOMBNO.: 1820-0517

OFFICEOFSPECIALEDUCATIONPARTB,INDIVIDUALSWITHDISABILITIESEDUCATIONACT

PROGRAMSIMPLEMENTATIONOFFAPEREQUIREMENTSFORMEXPIRES: 8/31/2007

2005

STATE:______

SECTIONF: RACE/ETHNICITYOFCHILDRENWITHDISABILITIESAGES3-5BYEDUCATIONALENVIRONMENT

EDUCATIONALENVIRONMENT / RACE/ETHNICITY
AMERICANINDIANORALASKANATIVE / ASIANORPACIFICISLANDER / BLACK
(NotHispanic) / HISPANIC / WHITE(NotHispanic) / TOTAL
(A)EARLYCHILDHOODSETTING
(B)EARLYCHILDHOODSPECIALEDUCATIONSETTING
(C)HOME
(D)PART-TIMEEARLYCHILDHOOD/
PART-TIMEEARLYCHILDHOODSPECIALEDUCATIONSETTING
(E)RESIDENTIALFACILITY
(F)SEPARATESCHOOL
(G)ITINERANTSERVICEOUTSIDETHEHOME(OPTIONAL)
(H)REVERSEMAINSTREAMSETTING(OPTIONAL)
(I)TOTAL(OFCOLUMNS):

EDFORM: 869-4

Theorderofthecategoriesdoesnotreflectacontinuumfromleasttomostrestrictive. Thecategoriesarealphabetized,withtheexceptionofthetwooptionalcategories,whicharelistedattheend.

U.S.DEPARTMENTOFEDUCATIONPAGE10OF10

OFFICEOFSPECIALEDUCATIONTABLE3(continued)

ANDREHABILITATIVESERVICESOMBNO.: 1820-0517

OFFICEOFSPECIALEDUCATIONPARTB,INDIVIDUALSWITHDISABILITIESEDUCATIONACT

PROGRAMSIMPLEMENTATIONOFFAPEREQUIREMENTSFORMEXPIRES: 8/31/2007

2005

STATE:______

SECTIONG: RACE/ETHNICITYOFCHILDRENWITHDISABILITIESAGES6-21BYEDUCATIONALENVIRONMENT

EDUCATIONALENVIRONMENT / RACE/ETHNICITY
AMERICANINDIANORALASKANATIVE / ASIANORPACIFICISLANDER / BLACK
(NotHispanic) / HISPANIC / WHITE(NotHispanic) / TOTAL
(A)SPECIALEDUCATIONOUTSIDEREGULARCLASSLESSTHAN21%OFDAY
(B)SPECIALEDUCATIONOUTSIDEREGULARCLASSATLEAST21%OFDAYANDNOMORETHAN60%OFDAY
(C)SPECIALEDUCATIONOUTSIDEREGULARCLASSMORETHAN60%OFDAY
(D)PUBLICSEPARATESCHOOL
(E)PRIVATESEPARATESCHOOL
(F)PUBLICRESIDENTIALFACILITY
(G)PRIVATERESIDENTIALFACILITY
(H)HOMEBOUND/HOSPITAL
(I)TOTAL(OFROWSA-H):
SECTIONH:RACE/ETHNICITYOFCHILDRENWITHDISABILITIESREPORTEDINSECTIONSDE
CORRECTIONALFACILITIES
CHILDRENWITHDISABILITIESENROLLEDINPRIVATESCHOOLSNOTPLACEDORREFERREDBYPUBLICAGENCIES

EDFORM: 869-4

ORIGINAL SUBMISSION/REVISION

CURRENT DATE: ______

[1]Children ages 3 through 9 may be reported under the category developmental delay in those States in which diagnostic instruments and procedures have been put in place to measure delays in one or more of the following areas: physical development, cognitive development, communication development, social or emotional development, or adaptive development. States must have defined and established eligibility criteria for developmental delay in order to use this category for reporting.

The reporting of data on developmental delay is optional. Neither States nor LEAs are required to use this category. States and LEAs having diagnostic instruments and procedures in place to measure delays in one or more of the specified areas may report the number of students having developmental delays at their discretion. Although states are not required to use the developmental delay category, if they use the category, then they must report children in the category.

2A private institution or school is a school NOT under Federal or public supervision or control and may be non-profit or proprietary.