**OM B NO. 1820** 
**- 0550**  **Expires:**

**AN NUA**  **L ST AT**  **E AP**  **PLICA TION UNDER PA**  **RT C OF THE INDIVIDUA**  **LS WITH DISABILITIES EDUCA TION A** **CT A S**  **AM ENDED IN 2004**  **FEDER AL** **FISCA L YEA**  **R (FFY) 20**  **15**

**CFDA No. 84.181A** 

**ED FORM No. 1 B20**
**-- 26P** 

**UNITED ST AT**  **ES DEPA RTMENT OF**  **EDUCA TION**  **OFFICE OF SPECIA L EDUCA**  **TION PROGRA MS**  **Washington, DC 20202**
**- 2600** 

**Paperwork Burden Statement** According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. Public reporting burden for this collection of information is estimated to average 10 hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and c om pleting and reviewing the collection of information. The obligation to respond to this collection is required to obtain or retain benefits (20 U.S.C. 1433; 20 U.S.C. 1435). Send comments regarding the burden estimate or any other aspect of this collectio n of information, including suggestions for reducing this burden, to the U.S. Department of Education, 400 Maryland Ave., SW, W ashington, DC 20210

-4537 or em ail ICDocketMgr@ed.gov and reference the OMB Control Numb er 1820

- 0550 . Note: Please do not return the completed Annual State Application form to this address.__________________ State

Part C Annual State Application: FFY 201 5 Section I

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- 0550/Expiration Date **Section I**

**A. Submission Statements for Part C of IDEA**  Select 1 or 2 below. Check 3 if appropriate. 1. _____ The State's policies, procedures, methods, descriptions, certifications, and assurances meet

all application requirements of Part C of the Act as found in the Individuals with Disabilities Education Act (IDEA), codified at 20 U.S.C. 1431 through 1443 and the Part C regulations in 34 CFR Part 303

. The State is able to provide and/or meet all policies, procedures, me thods, descriptions, and assurances, found in Sections II.A and II.B of this Application. By selecting this submission statement the State either has on file with the Secretary or has sub mi tted new or revised State policies, procedures, methods, and descriptions that meet all requirements found in Section II.A. 2. _____ The State cannot provide the policies, procedures, methods, descriptions, and/or

assurances for all application requirem ents of Part C of the Act as found in Part C of the IDEA, 20 U.S.C. 1431 through 1443 and the Part C regulations in 34 CFR Part 303. The State has determined that it is unable to provide the policies, procedures, methods, descriptions, and/or assurances t hat are checked 'No' in Sections II.A and II.B . However, the State assures that throughout the period of this grant award the State will operate consistent with all requirements of IDEA in 20 U.S.C. 1431 through 1443 and the final Part C regulations in 34 CFR Part 303. The State will develop and/or make such changes to existing policies, procedures, methods, descriptions, and assurances as are necessary to bring the policies, procedures, methods, descriptions, and assurances into compliance with the requi rements of the IDEA Part C Act and regulations, as amended, as soon as possible, and not later than June 30, 201 6

. The State has included the date by which it expects to com plete necessary changes associated with policies, procedures, methods, description s, and assurances marked 'No'. The item s checked ‘Yes’ in Section II.A are enclosed with this application as revised or new or are identified as “OF” already on file with the Secretary

. 1 Optional: 3. _____ The State is submitting new or modified State po licies and procedures previously submitted

to the Department and checked in Section II.A, “N”, “ R ” or “OF” cell(s) found in the 'Yes' column. These modifications are a result of: (1) the State revising its applicable State law or regulations; (2) changes required by the Secretary due to new interpretation of the Act or regulations by a Federal court or the State's highest court; and/or (3) because of an official finding of noncompliance with Federal law or regulation. **B. Conditional A** **pproval for Current G rant Year**  **If the State received conditional approval for the current grant year, check the statement(s) below: 1.**  **Conditional A pproval Related to A** **ssurances in Section II.A :**  _____ a. Sections II.A and II.B reflect completion of all issues identified in the FFY 201 4 conditional

approval letter (attach any additional docume ntation required by the FFY 201 4 letter)

. _____ b. As noted in Sections II.A and II.B, the State has not completed all issues identified in the

FFY 201 4 conditional approval letter. 2. **Co nditional A** **pproval Related to Other Issues:** _____ a. The State previously submitted documentation of completion of all issues identified in the

FFY 201 4 conditional approval letter. _____ b. The State is attaching documentation of completion of all issues identified in the FFY

201 4 conditional approval letter. (Attach documentation showing completion of all issues.) _____ c. The State has not completed all issues identified in the FFY 201 4 conditional approval

letter. (Attach documentation showing complet ion of any issues and a list of items not yet completed.)

1 If Option 2 is checked, the State is to provide dates in Sections II.A and II.B as to when the required policies, procedures, methods, d escriptions, and assurances will be provided, which date can be no later than June 30, 201 6

.__________________ State

Part C Annual State Application: FFY 201 5 Section II

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- 0550/Expiration Date: **Section II**

**A. State Policies, Procedures, Methods, and Descriptions**  As checked below, the State hereby declares that it has or has not filed the following policies, procedures, me thods, and descrip tions with the U.S. Department of Education, and, as of the date of the signature below, affirms and incorporates by reference those policies, procedures, methods, and descriptions with respect to Part C of the Individuals with Disabilities Education Act ( IDEA or Act) in 20 U.S.C. 1431

- 1443 and the final Part C regulations in 34 CFR Part 303 (Part C). By submission of this Section II, the State assures that throughout the period of this FFY 201 4 grant award, the State will operate consistent with all req uirements of Part C of the IDEA in 20 U.S.C. 1431 through 1443 and the final Part C regulations in 34 CFR Part 303. The State will develop and/or make such changes to existing policies, procedures, me thods, descriptions, and assurances as are necessary to bring the policies, procedures, methods, descriptions, and assurances into compliance with the requirements of the IDEA Part C Act and final regulations by the date indicated below and not later than June 30, 201 6

.
Check and enter date(s) as applicable. Enclose relevant documents. N = 'New' Policy and/or Procedure R = 'Revised' Policy and/or Procedure OF = Policy and/or Procedure is already 'On File' with the USDE **Yes** (If New or Revised is checked, the State is submitting policies, procedures, methods, and descriptions with this application. If already 'On File with OSEP', check OF.) **No** (Policies, procedures, methods, and descriptions have not been provided. Provide date by which State will submit to OSEP required documentation, which date shall be no later than June 30, 201 6 .)
**N R**  **OF State Policies, Procedures, Methods, and Descriptions**  **Subpart C**

**– State Policies and Procedures** 

1. Each application must include the name of the State lead agency, as designated under §303.120, that will be re sponsible for the administration of funds provided under this part. (34 CFR §303.201)

2. Each application must include a description of services to be provided under Part C to infants and toddlers with disabilities and their families through the State ’s system. (34 CFR §303.203(a))

3. Each application must include the State’s policies and procedures regarding the identification and coordination of all available resources within the State from Federal, State, local, and private sources as required un der subpart F of 34 CFR Part 303. The State must have policies and procedures that meet the requirements listed in 3(a) and the methods identified in 3(b), and must provide responses to those__________________ State

Part C Annual State Application: FFY 201 5 Section II

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- 0550/Expiration Date: Check and enter date(s) as applicable. Enclose relevant documents. N = 'New' Policy and/or Procedure R = 'Revised' Policy and/or Procedure OF = Policy and/or Procedure is already 'On File' with the USDE **Yes** (If New or Revised is checked, the State is submitting policies, procedures, methods, and descriptions with this application. If already 'On File with OSEP', check OF.) **No** (Policies, procedures, methods, and descriptions have not been provided. Provide date by which State will submit to OSEP required documentation, which date shall be no later than June 30, 201 6 .)
**N R**  **OF State Policies, Procedures, Methods, and Descriptions**  entries. If the State has not adopted a system of payments, it may respond “NA” to 3(a). (a) If the State has adopted a system of payme nts, each application must include any policies or procedures adopted by the State as its system of payme nts and those policies and procedures mu st m eet the requirements in §§ 3 03.510, 303.520 and 303.521 (regarding the use of public insurance or benefits, private insurance, or family costs or fees). (34 CFR §303.203(b)(1)) **The policies and procedures listed in 3(a) are optional** 

**. Enter 'NA' in the cells to the left if the**  **Stat e has elected not to adopt a system of**  **payments (which includes a system to use public**  **insurance or benefits or private insurance or**  **family fees to pay for Part C services)**  **; otherwise check the appropriate response under the 'Yes'**  **column and, if checking ‘ N’ or ‘R’**  **, attach**  **policies and procedures.**  **The State’s response under 3(a) of Section II**

**. A**  **must match the State’s response under Section IV.A.**  (b) Each application must include the methods (State law, regulation , signed interagenc y or intra

agenc y agreem ents or other appropriate written me thod(s) approved by the Secretary)used by the State to implement the payor of last resort and fiscal responsibility requirements in §303.511( b )(2) and (3). (34 CFR §303.203(b)(2)) **If the State use s**  **signed interagen cy agreements**  **or “other appropriate written method(s)**  **” to meet** __________________ State

Part C Annual State Application: FFY 201 5 Section II

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- 0550/Expiration Date: Check and enter date(s) as applicable. Enclose relevant documents. N = 'New' Policy and/or Procedure R = 'Revised' Policy and/or Procedure OF = Policy and/or Procedure is already 'On File' with the USDE **Yes** (If New or Revised is checked, the State is submitting policies, procedures, methods, and descriptions with this application. If already 'On File with OSEP', check OF.) **No** (Policies, procedures, methods, and descriptions have not been provided. Provide date by which State will submit to OSEP required documentation, which date shall be no later than June 30, 201 6 .)
**N R**  **OF State Policies, Procedures, Methods, and Descriptions**  **the requirements in 3(b) , please check ‘N’ or ‘R’**  **and submit with the application**

**. If the State’s**  **method is a State statute or regulation, the State does not need to submit that method (the st**  **atute or regulation) with its application.** 

4. Each application must include the State’s rigorous definition of developmental delay as required under §§303.10 and 303.111. Each Statewide s ys tem must include the State's rigorous definition of developme ntal delay , consistent with §§303.10 and 303.203(c), that will be used by the State in carryi ng out programs under Part C of the Act in order to appropriately identify infants and toddlers with disabilities who are in need of services under Part C of the Act. The definition must

-- (a) Describe, for each of the areas listed in §303.21(a)(1), the evaluation and assessment procedures, consistent with §303.321, that will be used to measure a child's development; and (b) Specify the level of developmental delay in functioning or other comparable criteria that constitute a developmental delay in one or more of the developmental areas identified in §303.21(a)(1). (34 CFR §§303.203(c) & 303.111)

5. If the State provides services under Part C to at

- risk infants and toddlers through the statewide system, the application must include

-- (a) The State’s definition of at

- risk infants and toddlers with disabilities who are eligible in the State for services under Part C (consistent with §§303.5 and 303.21(b)); and (b) A description of the early intervention services__________________ State

Part C Annual State Application: FFY 201 5 Section II

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- 0550/Expiration Date: Check and enter date(s) as applicable. Enclose relevant documents. N = 'New' Policy and/or Procedure R = 'Revised' Policy and/or Procedure OF = Policy and/or Procedure is already 'On File' with the USDE **Yes** (If New or Revised is checked, the State is submitting policies, procedures, methods, and descriptions with this application. If already 'On File with OSEP', check OF.) **No** (Policies, procedures, methods, and descriptions have not been provided. Provide date by which State will submit to OSEP required documentation, which date shall be no later than June 30, 201 6 .)
**N R**  **OF State Policies, Procedures, Methods, and Descriptions**  provided under Part C to at

- risk infants and toddlers with disabilities who meet the State’s definition described in §303.204(a). (34 CFR §303.204). **The policies and procedures listed in 5 are opti** **onal (i.e., they only apply if the State opts to**  **serve at -** **risk children)**

**. Enter 'NA' in the cells to**  **the left if the State has elected not to provide services under Part C to at** 
**- risk infants and**  **toddlers; otherwise check the appropriate response under the**  **'Yes' column and, if checking ‘N’ or ‘R’, attach**  **the definition and description** 

**.** 6. Each State application must include a description of the State’s use of funds under Part C for the fiscal ye ar or years covered by the application. The description mu st be presented separately for the lead agenc y and the State Interagenc y Coordinating Council (Council), and include the information required in attached Section III of this application. (34 CFR §303.205)

7. Each application must include the State’s policies and procedures that require the referral for early intervention services under Part C of specific children under the age of three, as described in §303.30 3 (b) (which includes children who are the subject of a substantiated case of abuse or neglect , or directly affected by illegal substance abuse or withdrawal symp toms resulting from prenatal drug exposure ) . (34 CFR §303.206)

8. Each application must include a description of the procedure used by the State to ensure that resources are made ava ilable under Part C for all geographic areas within the State. (34 CFR §303.207)__________________ State

Part C Annual State Application: FFY 201 5 Section II

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- 0550/Expiration Date: Check and enter date(s) as applicable. Enclose relevant documents. N = 'New' Policy and/or Procedure R = 'Revised' Policy and/or Procedure OF = Policy and/or Procedure is already 'On File' with the USDE **Yes** (If New or Revised is checked, the State is submitting policies, procedures, methods, and descriptions with this application. If already 'On File with OSEP', check OF.) **No** (Policies, procedures, methods, and descriptions have not been provided. Provide date by which State will submit to OSEP required documentation, which date shall be no later than June 30, 201 6 .)
**N R**  **OF State Policies, Procedures, Methods, and Descriptions** 

9. Each application must include a description of the policies and procedures used by the State to ensure that, before adopting any new polic y or procedure (including an y revision to an existing policy or procedure) needed to comply with Part C of the Act and 34 CFR Part 303, the lead agency

-- (1) Holds public hearings on the new polic y or procedure (including any revision to an existing polic y or procedure); (2) Provides notice of the hearings held in accordance with §303. 208 (b)(1) at least 30 days before the hearings are conducted to enable public participation; and (3) Provides an opportunity for the general public, including individuals with disabilities, parents of in fants and toddlers with disabilities, EIS providers, and the members of the Council, to comment for at least 30 days on the new policy or procedure (including any revision to an existing policy or procedure) needed to comply with Part C of the Act and 34 C FR Part 303. (34 CFR §303.208(b))

10. (a) Application Requirements : Each State must include the following in its application: (1) A description of the policies and procedures it will use to ensure a smooth transition for infants and toddlers with d isabilities under the age of three and their families from receiving early intervention services under Part C to preschool or other appropriate services (for toddlers with disabilities) or exiting the program for infants and toddlers with disabilities.__________________ State

Part C Annual State Application: FFY 201 5 Section II

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- 0550/Expiration Date: Check and enter date(s) as applicable. Enclose relevant documents. N = 'New' Policy and/or Procedure R = 'Revised' Policy and/or Procedure OF = Policy and/or Procedure is already 'On File' with the USDE **Yes** (If New or Revised is checked, the State is submitting policies, procedures, methods, and descriptions with this application. If already 'On File with OSEP', check OF.) **No** (Policies, procedures, methods, and descriptions have not been provided. Provide date by which State will submit to OSEP required documentation, which date shall be no later than June 30, 201 6 .)
**N R**  **OF State Policies, Procedures, Methods, and Descriptions**  ( 2) A description of how the State will meet each requirement in §303.209(b) through (f). (3) (i)(A) If the lead agency is not the SEA, an interagency agreement between the lead agenc y and the SEA ; or (B) If the lead agenc y is the SEA, an intra

- agency ag reement between the program within that agenc y that administers Part C of the Act and the program within the agency that adm inisters section 619 of the Act (ii) To ensure a seamless transition between services under Part C and under Part B of the Act, an interagency agreement under paragraph (a)(3)(i)(A) of this section or an intra

- agenc y agreement under paragraph (a)(3)(i)(B) of this section must address how the lead agency and the SEA will meet the requirements of paragraphs (b) through (f) of this secti on (including any policies adopted by the lead agency under §303.401(d) and (e)), §303.344(h), and 34 CFR 300.101(b), 300.124, 300.321(f) and 300.323(b). (4) An y polic y the lead agency has adopted under §303.401 (d) and (e)

. (b) Notification to the SEA and appropriate LEA . The State must ensure that

-- (1) Subject to paragraph (b)(4) of this section, not fewer than 90 days before the third birthday of the toddler with a disability if that toddler ma y be eligible for preschool services under Part B of the Act , the lead agency notifies the SEA and the LEA for the area in which the toddler resides that the toddler on his or her third birthday will reach the age of eligibility for services under Part B of the Act, as determined in accordance with State law; or (2 ) Subject to paragraph (b)(4) of this section, if__________________ State

Part C Annual State Application: FFY 201 5 Section II

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- 0550/Expiration Date: Check and enter date(s) as applicable. Enclose relevant documents. N = 'New' Policy and/or Procedure R = 'Revised' Policy and/or Procedure OF = Policy and/or Procedure is already 'On File' with the USDE **Yes** (If New or Revised is checked, the State is submitting policies, procedures, methods, and descriptions with this application. If already 'On File with OSEP', check OF.) **No** (Policies, procedures, methods, and descriptions have not been provided. Provide date by which State will submit to OSEP required documentation, which date shall be no later than June 30, 201 6 .)
**N R**  **OF State Policies, Procedures, Methods, and Descriptions**  the lead agency determines that the toddler is eligible for early intervention services under Part C of the Act more than 45 but less than 90 days before that toddler’s third birthday and if that toddler ma y be eligible for preschool services under Part B of the Act, the lead agency, as soon as possible after determining the child’s eligibility, notifies the SEA and the LEA for the area in which the toddler with a disability resides that the toddler on his o r her third birthday will reach the age of eligibility for services under Part B of the Act, as determined in accordance with State law; or (3) Subject to paragraph (b)(4) of this section, if a toddler is referred to the lead agency fewer than 45 days befo re that toddler’s third birthday and that toddler may be eligible for preschool services under Part B of the Act, the lead agency, with parental consent required under §303.414, refers the toddler to the SEA and the LEA for the area in which the toddler re sides; but, the lead agenc y is not required to conduct an evaluation, assessment, or an initial IFSP meeting under these circumstances; (4) The notification required under paragraphs (b)(1), (2), and (3) of this section is consistent with any policy that the State has adopted, under §303.401(e), permitting a parent to object to disclosure of personally identifiable information. (c) Conference to discuss services . The State must ensure that

— (1) If a toddler with a disability may be eligible for preschool services under Part B of the Act, the lead agency, with the approval of__________________ State

Part C Annual State Application: FFY 201 5 Section II

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- 0550/Expiration Date: Check and enter date(s) as applicable. Enclose relevant documents. N = 'New' Policy and/or Procedure R = 'Revised' Policy and/or Procedure OF = Policy and/or Procedure is already 'On File' with the USDE **Yes** (If New or Revised is checked, the State is submitting policies, procedures, methods, and descriptions with this application. If already 'On File with OSEP', check OF.) **No** (Policies, procedures, methods, and descriptions have not been provided. Provide date by which State will submit to OSEP required documentation, which date shall be no later than June 30, 201 6 .)
**N R**  **OF State Policies, Procedures, Methods, and Descriptions**  the family of the toddler, convenes a conference, among the lead agency, the fa mi ly , and the LEA not fewer than 90 days

-- and, at the discretion of all of the parties, not mo re than 9 m onths

-- before the toddler’s third birthday to discuss any services the toddler may receive under Part B of the Act. (2) If a toddler with a disability is determined to not be potentially eligible for preschool services under Part B of the Act, the lead age nc y, with the approval of the family of that toddler, makes reasonable efforts to convene a conference among the lead agenc y, the family, and providers of other appropriate services for the toddler to discuss appropriate services that the toddler ma y recei ve. (d) Transition plan . The State must ensure that for all toddlers with disabilities

– (1)(i) It reviews the program options for the toddler with a disability for the period from the toddler's third birthday through the remainder of the school year; an d (ii) Each family of a toddler with a disability who is served under Part C is included in the development of the transition plan required under this section and §303.344(h) ; (2) It establishes a transition plan in the IFSP not fewer than 90 days -- and, at the discretion of all of the parties, not more than 9 months

-- before the toddler’s third birthday; and (3) The transition plan in the IFSP includes, consistent with §303.344(h), as appropriate

— (i) Steps for the toddler with a disability__________________ State

Part C Annual State Application: FFY 201 5 Section II

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- 0550/Expiration Date: Check and enter date(s) as applicable. Enclose relevant documents. N = 'New' Policy and/or Procedure R = 'Revised' Policy and/or Procedure OF = Policy and/or Procedure is already 'On File' with the USDE **Yes** (If New or Revised is checked, the State is submitting policies, procedures, methods, and descriptions with this application. If already 'On File with OSEP', check OF.) **No** (Policies, procedures, methods, and descriptions have not been provided. Provide date by which State will submit to OSEP required documentation, which date shall be no later than June 30, 201 6 .)
**N R**  **OF State Policies, Procedures, Methods, and Descriptions**  and his or her fa mi ly

to exit from the Part C program; and (ii) An y transition services that the IFSP Team identifies as needed by that toddler and his or her family. (e) Transition conference and plan meeting requirements . Any conference conducted under paragraph (c) of this section or meeting to develop the transition plan under paragraph (d) of this section (which conference and meeting may be com bined into one meeting) must meet the requirements in §§303.342(d) and (e) and 303.343(a). (f) Applicability of transition requirements

. (1) The transition requirements in paragraphs (b)(1) and (2), (c)(1), and (d) of this section apply to all toddlers with disabilities receiving services under this part before those toddlers turn age three , including any toddler with a di sability under the age of three who is served by a State that offers services under §303.211

. (2) In a State that offers services under §303.211, for toddlers with disabilities identified in paragraph (b)(1) of this section, the parent must be provided a t the transition conference conducted under paragraph (c)(1) of this section: (i) An explanation, consistent with §303.211(b)(1)(ii), of the toddler’s options to continue to receive early intervention services under this part or preschool services under section 619 of the Act ; (ii) The initial annual notice referenced in §303.211(b)(1). (3) For children with disabilities age three and older who receive services pursuant to §303.211, the State must ensure that it satisfies the separate transition requirem ents in §303.211(b)(6) (ii)

. (34 CFR §303.209)__________________ State

Part C Annual State Application: FFY 201 5 Section II

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- 0550/Expiration Date: Check and enter date(s) as applicable. Enclose relevant documents. N = 'New' Policy and/or Procedure R = 'Revised' Policy and/or Procedure OF = Policy and/or Procedure is already 'On File' with the USDE **Yes** (If New or Revised is checked, the State is submitting policies, procedures, methods, and descriptions with this application. If already 'On File with OSEP', check OF.) **No** (Policies, procedures, methods, and descriptions have not been provided. Provide date by which State will submit to OSEP required documentation, which date shall be no later than June 30, 201 6 .)
**N R**  **OF State Policies, Procedures, Methods, and Descriptions** 

11. Each application must contain a description of State efforts to promote collaboration among Head Start and Early Head Start programs under the Head Start Act (42 U.S.C. 9801, et seq

. , as amended ), early education and child care programs, and services under Part C. (34 CFR §303.210)

12. Each application must include, as required by Section 427 of the General Education Provisions Act (GEPA), a description of how the State has identified barriers and developed strategies to address the barriers and has provided a description of the steps the State is taking to ensure equitable access to, and participation in, Part C. (34 CFR §303.212(a)) 13. (a) (1) A State may elect to include in its app lication for a grant under Part C a State polic y, developed and im plem ented jointly by the lead agency and the SEA, under which a parent of a child with a disability who is eligible for preschool services under section 619 of the Act and who previously rec eived early intervention services under Part C, may choose the continuation of early intervention services under Part C for his or her child after the child turns three until the child enters, or is eligible under State law to enter, kindergarten or elem en tary school. (2) A State that adopts the policy described in paragraph (a)(1) of this section may determine whether it applies to children with disabilities

--

(i) From age three until the beginning of the school year following the child’s third birthday; ( ii) From age three until the beginning of the school year following the child’s fourth birthday; or (iii) From age three until the beginning of the school year following the child’s fifth__________________ State

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- 0550/Expiration Date: Check and enter date(s) as applicable. Enclose relevant documents. N = 'New' Policy and/or Procedure R = 'Revised' Policy and/or Procedure OF = Policy and/or Procedure is already 'On File' with the USDE **Yes** (If New or Revised is checked, the State is submitting policies, procedures, methods, and descriptions with this application. If already 'On File with OSEP', check OF.) **No** (Policies, procedures, methods, and descriptions have not been provided. Provide date by which State will submit to OSEP required documentation, which date shall be no later than June 30, 201 6 .)
**N R**  **OF State Policies, Procedures, Methods, and Descriptions**  birthday. (3) However, in no case m ay a State provide services under this section beyond the age at which the child actually enrolls in, or is eligible under State law to enter, kindergarten or elementary school in the State. (b) Requirements . If a State’s application for a grant under Part C includes the State policy des cribed in paragraph (a) of this section, the system must ensure the following: (1) Parents of children with disabilities who are eligible for services under section 619 of the Act and who previously received early intervention services under Part C will be provided annual notice (the initial annual notice must be provided as set forth in §303.209(f)(2)(ii)) that contains

-- (i) A description of the rights of the parents to elect to receive services pursuant to §303.211 or under Part B of the Act; and (ii) An explanation of the differences between services provided pursuant to §303.211 and services provided under Part B of the Act, including

-- (A ) The types of services and the locations at which the services are provided; (B) The procedural safeguards tha t apply; and (C) Possibl e costs (including the costs or fees to be charged to families as described in §§303.520 and 303.521), if any, to parents ; and (2) Consistent with §303.344(d), services provided pursuant to §303.211 will include an educational co mp onent that promotes school readiness and incorporates preliterac y, language, and numeracy skills.__________________ State

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- 0550/Expiration Date: Check and enter date(s) as applicable. Enclose relevant documents. N = 'New' Policy and/or Procedure R = 'Revised' Policy and/or Procedure OF = Policy and/or Procedure is already 'On File' with the USDE **Yes** (If New or Revised is checked, the State is submitting policies, procedures, methods, and descriptions with this application. If already 'On File with OSEP', check OF.) **No** (Policies, procedures, methods, and descriptions have not been provided. Provide date by which State will submit to OSEP required documentation, which date shall be no later than June 30, 201 6 .)
**N R**  **OF State Policies, Procedures, Methods, and Descriptions**  (3) The State polic y ensures that any child served pursuant to this section has the right, at any time, to receive FAPE (as that term is defined at §303.15) under Part B of the Act instead of early intervention services under Part C of the Act under §303.211. (4) The lead agency must continue to provide all early intervention services identified in the toddler with a disability’s IFSP under §303.344 (and cons ented to by the parent under §303.342(e)) beyond age three until that toddler’s initial eligibility determination under Part B of the Act is made under 34 CFR §300.306. This provision does not apply if the LEA has requested parental consent for the initia l evaluation under §300.300(a) and the parent has not provided that consent. (5) The lead agency must obtain informed consent from the parent of any child with a disability for the continuation of early intervention services pursuant to this section for th at child. Consent must be obtained before the child reaches three years of age, where practicable. ( 6)(i) For toddlers with disabilities under the age of three in a State that offers services under this section, the lead agenc y ensures that the transiti on requirements in §303.209(b)(1) and (2), (c)(1) and (d) are met. (ii) For toddlers with disabilities age three and older in a State that offers services under this section, the lead agenc y ensures a smooth transition from services under this section to preschool, kindergarten or elementary school by: (A) Providing the SEA and LEA where the child resides, consistent with any State policy adopted__________________ State

Part C Annual State Application: FFY 201 5 Section II

- 14 OMB No. 1820

- 0550/Expiration Date: Check and enter date(s) as applicable. Enclose relevant documents. N = 'New' Policy and/or Procedure R = 'Revised' Policy and/or Procedure OF = Policy and/or Procedure is already 'On File' with the USDE **Yes** (If New or Revised is checked, the State is submitting policies, procedures, methods, and descriptions with this application. If already 'On File with OSEP', check OF.) **No** (Policies, procedures, methods, and descriptions have not been provided. Provide date by which State will submit to OSEP required documentation, which date shall be no later than June 30, 201 6 .)
**N R**  **OF State Policies, Procedures, Methods, and Descriptions**  under §303.401(e), the information listed in §303.401(d)(1) not fewer than 90 days before the child will no longer be eligible under subsection (a)(2) of this section to receive early intervention services under this section; (B) Wi th the approval of the parents of the child, convening a transition conference, among the lead agency, the parents, and the LEA , not fewer than 90 days -- and, at the discretion of all parties, not more than 9 months

-- before the child will no longer be eligible under subsection (a)(2) of this section to receive , or will no longer receive, early intervention services under this secti on, to discuss any services that the child may

receive under Part B of the Act; and (C ) Establishing a transition plan in the IFSP not fewer than 90 days -- and, at the discretion of all parties, not more than 9 months

-- before the child will no longer be el igible under subsection (a)(2) of this section to receive , or no longer receives, early intervention services under this section. (7) In States that adopt the option to make services under Part C available to children ages three and older pursuant to §303. 211 , there will be a referral to the Part C system, dependent upon parental consent, of a child under the age of three who directly experiences a substantiated case of trauma due to exposure to family violence, as defined in section 320 of the Family Viole nce Prevention and Services Act, 42 U.S.C. 10401, et seq. (c) Reporting requirement . If a State includes in its application a State policy described in §303.211 (a), the State must submit to the Secretary, in the State’s report under §303.124, the number a nd percentage of children with disabilities who are eligible for services under__________________ State

Part C Annual State Application: FFY 201 5 Section II

- 15 OMB No. 1820

- 0550/Expiration Date: Check and enter date(s) as applicable. Enclose relevant documents. N = 'New' Policy and/or Procedure R = 'Revised' Policy and/or Procedure OF = Policy and/or Procedure is already 'On File' with the USDE **Yes** (If New or Revised is checked, the State is submitting policies, procedures, methods, and descriptions with this application. If already 'On File with OSEP', check OF.) **No** (Policies, procedures, methods, and descriptions have not been provided. Provide date by which State will submit to OSEP required documentation, which date shall be no later than June 30, 201 6 .)
**N R**  **OF State Policies, Procedures, Methods, and Descriptions**  section 619 of the Act but whose parents choose for their children to continue to receive early intervention services under §303.211

. (d) Available funds . The State policy des cribed in §303.211 (a) must describe the funds

-- including an identification as Federal, State, or local funds

-- that will be used to ensure that the option described in §303.211 (a) is available to eligible children and families who provide the consent descri bed in §303.211 (b)(5), including fees, if any, to be charged to families as described in §§303.520 and 303.521. (e) Rules of construction . (1) If a statewide system includes a State policy described in §303.211 (a), a State that provides services in accordance with this section to a child with a disability who is eligible for services under section 619 of the Act will not be required to provide the child FAPE under Part B of the Act for the period of time in which the child is receiving services under §303 .211

. (2) Nothing in this section may be construed to require a provider of services under Part C to provide a child served under Part C with FAPE. (34 CFR §303.211) **The policies and procedures listed in 13 are optional.**  **Enter 'NA' in the cells to the left if the**  **State has elected not to develop and implement a policy under 34 CFR §303.211**  **to make Part C services to children beyond age three** **; otherwise check the appropriate response under the 'Yes'**  **column and, if checking ‘N’ or ‘R’, attach policies and pro**  **cedures.**__________________ State

Part C Annual State Application: FFY 201 5 Section II

- 16 OMB No. 1820

- 0550/Expiration Date: **B. Assurances and Optional A** **ssurance** The State makes the following assurances and provisions as required by Part C of the Individuals with Disabilities Education Act. (20 U.S.C. 1431 et. seq.; 34 CFR §§ 303.101

- 126; 303.220; 303.227)

Check and enter date(s) as applicable **Subpart B**

**– As**  **surances** (20 U.S.C. 1434; 1435; and 1437(b); 34 CFR §§ 303.101

- 126; 303.220; 303.227)

**Yes** (Assurance is hereby provided.) **No**

(Assurance cannot be ensured. Provide date on which State will complete changes in order to provide assurance.)
1. The State has adopted a polic y that appropriate early intervention

services , as defined in 34 CFR §303.13, are available to all infants and toddlers with disabilities in the State and their families, including

-- (a) Indian in fants and toddlers with disabilities and their families residing on a reservation geographically located in the State; (b) Infants and toddlers with disabilities who are homeless children and their families; and (c) Infants and toddlers with disabilities who are wards of the State. (34 CFR §303.101(a))

2. The State has in effect a statewide s ys tem of early intervention services that meets the requirements of section 635 of the Act, including policies and procedures that address, at a minimum, the compon ents required in 34 CFR §§303.111 through 303.126. (34 CFR §303.101(a))

3. The State ensures that any State rules, regulations, policies and procedures relating to 34 CFR Part 303 conform to the purposes and requirements of 34 CFR Part 303. (34 CFR §3 03.102)

4. Each statewide s ys tem (system) must include, at a minimum, the com ponents described in §§303.111 through 303.126. (34 CFR §303.110)

5. The State has a polic y in effect that ensures that appropriate early intervention services are based on scientifically based research, to the extent practicable, and are available to all infants and toddlers with disabilities and their families, including

— (a) Indian infants and toddlers with disabilities and their families residing on a reservation geograp hically located in the State; and (b) Infants and toddlers with disabilities who are homeless children and their families. (34 CFR §303.112)__________________ State

Part C Annual State Application: FFY 201 5 Section II

- 17 OMB No. 1820

- 0550/Expiration Date: Check and enter date(s) as applicable **Subpart B**

**– As**  **surances** (20 U.S.C. 1434; 1435; and 1437(b); 34 CFR §§ 303.101

- 126; 303.220; 303.227)

**Yes** (Assurance is hereby provided.) **No**

(Assurance cannot be ensured. Provide date on which State will complete changes in order to provide assurance.)
6. (a) The Statewide system ensures the performance of

-- (1) A tim ely, comprehensive, multidisciplinary evalua tion of the functioning of each infant or toddler with a disability in the State; and (2) A family

- directed identification of the needs of the family of the infant or toddler to assist appropriately in the development of the infant or toddler. (b) The eva luation and family

- directed identification required in paragraph (a) of this section must meet the requirements of 34 CFR §303.321. (34 CFR §303.113)

7. The Statewide system ensures that, for each infant or toddler with a disability and his or her famil y in the State, an IFSP , as defined in 34 CFR §303.20, is developed and implemented that meets the requirements of 34 CFR §§303.340 through 303. 345 and that includes service coordination services , as defined in 34 CFR §303.34

. (34 CFR §303.114)

8. The Statewide system includes a comprehensive child find system that me ets the requirements in 34 CFR §§303. 302 and 303.303. (34 CFR §303.115)

9. The Statewide system includes a public awareness program that

-- (a) Focuses on the early identification of infants and toddlers with disabilities; and (b) Provides information to parents of infants and toddlers through primary referral sources in accordance with 34 CFR §303. 301

. (34 CFR §303.116)

10. The Statewide system includes a central directory that is accessible to the general public (i.e., through the lead agenc y’s W eb site and other appropriate means) and includes accurate, up

-to

- date information about: (a) Public and private early intervention services, resources, and experts available in the State; ( b) Professional and other groups (including parent support and training and information centers, such as those funded under the Act) that provide assistance to infants and toddlers with disabilities__________________ State

Part C Annual State Application: FFY 201 5 Section II

- 18 OMB No. 1820

- 0550/Expiration Date: Check and enter date(s) as applicable **Subpart B**

**– As**  **surances** (20 U.S.C. 1434; 1435; and 1437(b); 34 CFR §§ 303.101

- 126; 303.220; 303.227)

**Yes** (Assurance is hereby provided.) **No**

(Assurance cannot be ensured. Provide date on which State will complete changes in order to provide assurance.) eligible under Part C of the Act and their families; and

(c) Research and demonstration projects being conducted in the State relating to infants and toddlers with disabilities. ( 34 CFR §303.117)

11. The Statewide system includes a comprehensive s ys tem of personnel development, including the training of para professionals and the training of primary referral sources with respect to the basic components of early intervention services available in the State. The State’s comprehensive system of personnel development

-- (a) Includes

-- (1) Training personnel to imp lem ent innovative strategies and activities for the recruitment and retention of EIS providers; (2) Promoting the preparation of EIS providers who are fully and appropriately qualified to provide early intervention services under Part C; and (3) Training p ersonnel to coordinate transition services for infants and toddlers with disabilities who are transitioning from an early intervention services program under Part C of the Act to a preschool program under section 619 of the Act, Head Start, Early Head Start, an elementary school program under Part B of the Act, or another appropriate program

. (b) May include

-- (1) Training personnel to work in rural and inner

- city areas; (2) Training personnel in the emotional and social development of young children ; (3 ) Training personnel to support families in participating fully in the development and implementation of the child’s IFSP; and (4) Training personnel who provide services under this part using standards that are consistent with early learning personnel development standards funded under the State Advisory Council on Early Childhood Education and Care established under the Head Start Act, if applicable. **(** 34 CFR §303.118)

12. The Statewide system includes policies and procedures relating to th e establishment and maintenance of qualification standards to ensure that personnel necessary to carry out the purposes of Part C are appropriately and adequately prepared and trained. These policies and procedures provide for the establishment and mainte nance of__________________ State

Part C Annual State Application: FFY 201 5 Section II

- 19 OMB No. 1820

- 0550/Expiration Date: Check and enter date(s) as applicable **Subpart B**

**– As**  **surances** (20 U.S.C. 1434; 1435; and 1437(b); 34 CFR §§ 303.101

- 126; 303.220; 303.227)

**Yes** (Assurance is hereby provided.) **No**

(Assurance cannot be ensured. Provide date on which State will complete changes in order to provide assurance.) qualification standards that are consistent with any State

- approved or State

- recognized certification, licensing, registration, or other com parable requirements that apply to the profession, discipline, or area in which personnel are providing ear ly intervention services. Nothing in Part C of the Act may

be construed to prohibit the use of paraprofessionals and assistants who are appropriately trained and supervised in accordance with State law, regulation, or written polic y, to assist in the prov ision of early intervention services under Part C of the Act to infants and toddlers with disabilities. (34 CFR §303.119(a)

– (c))

13. The Statewide system includes a single line of responsibility in a lead agenc y designated or established by the Gover nor that is responsible for the following

-- (a)(1) The general administration and supervision of programs and activities adm inistered by agencies, institutions, organizations, and EIS providers receiving assistance under Part C of the Act; and (2) The m onitoring of programs and activities used by the State to carry out Part C of the Act (whether or not the programs or activities are adm inistered by agencies, institutions, organizations, and EIS providers that are receiving assistance under Part C of the Act), to ensure that the State com plies with Part C of the Act, including

-- (i) Monitoring agencies, institutions, organizations, and EIS providers used by the State to carry out Part C of the Act; (ii) Enforcing any obligations imposed on those agencies , institutions, organizations, and EIS providers under Part C of the Act and 34 CFR Part 303; (iii) Providing technical assistance, if necessary, to those agencies, institutions, organizations and EIS providers ; (iv) Correcting any noncompliance identified through mo nitoring as soon as possible and in no case later than one year after the lead agency’s identification of the noncompliance; and (v) Conducting the activities in paragraphs (a)(2)(i) through (a)(2)(iv) of this section, consistent with 34 CFR §§3 03.700 through 303.707, and any other activities required by the State under those sections. (b) The identification and coordination of all available resources for early intervention services within the State, including those from Federal, State, local, an d private sources, consistent with subpart F__________________ State

Part C Annual State Application: FFY 201 5 Section II

- 20 OMB No. 1820

- 0550/Expiration Date: Check and enter date(s) as applicable **Subpart B**

**– As**  **surances** (20 U.S.C. 1434; 1435; and 1437(b); 34 CFR §§ 303.101

- 126; 303.220; 303.227)

**Yes** (Assurance is hereby provided.) **No**

(Assurance cannot be ensured. Provide date on which State will complete changes in order to provide assurance.) of 34 CFR Part 303.

(c) The assignment of financial responsibility in accordance with subpart F of 34 CFR Part 303. (d) The development of procedures in accordance with subpart F of 34 CFR Part 303 to ensure th at early intervention services are provided to infants and toddlers with disabilities and their families under Part C of the Act in a timely manner, pending the resolution of any disputes among public agencies or EIS providers. (e) The resolution of intra

- and interagency disputes in accordance with subpart F of 34 CFR Part 303. (f) The entry into formal interagency agreements or other written me thods of establishing financial responsibility, consistent with 34 CFR §303.511, that define the financial respo nsibility of each agenc y for paying for early intervention services (consistent with State law) and procedures for resolving disputes and that include all additional components necessary to ensure meaningful cooperation and coordination as set forth in sub part F of 34 CFR Part 303. (34 CFR §303.120)

14. The Statewide system includes a policy pertaining to the contracting or ma king of other arrangements with public or private individuals or agenc y service providers to provide early intervention services i n the State, consistent with the provisions of Part C of the Act and 34 CFR Part 303, including the contents of the application, and the conditions of the contract or other arrangements. The polic y -- (a) Includes a requirement that all early interventio n services must me et State standards and be consistent with the provisions of Part C; and (b) Is consistent with the Education Department General Adm inistrative Regulations in 34 CFR Part 80. (34 CFR §303.121)

15. The Statewide system includes proce dures for securing the timely reimbursement of funds used under Part C of the Act, in accordance with subpart F of 34 CFR Part 303. (34 CFR §303.122)

16. The Statewide system includes procedural safeguards that meet the requirements of subpart E of 34 CFR Part 303. (34 CFR §303.123)__________________ State

Part C Annual State Application: FFY 201 5 Section II

- 21 OMB No. 1820

- 0550/Expiration Date: Check and enter date(s) as applicable **Subpart B**

**– As**  **surances** (20 U.S.C. 1434; 1435; and 1437(b); 34 CFR §§ 303.101

- 126; 303.220; 303.227)

**Yes** (Assurance is hereby provided.) **No**

(Assurance cannot be ensured. Provide date on which State will complete changes in order to provide assurance.)
17. The Statewide system includes a system for compiling and reporting

tim ely and accurate data that meets the requirements of 34 CFR §§303.700 through 303.702 and 303.720 through 303.724 and the following requirements. The data system includes a description of the process that the State uses, or will use, to compile data on infants or toddlers with disabilities receiving early intervention services under Part C, including a description of the State’s sampling methods, i f sampling is used, for reporting the data required by the Secretary under sections 616 and 618 of the IDEA and 34 CFR §§303.700 through 303.707 and 303.720 through 303.724. (34 CFR §303.124)

18. The Statewide system includes a State Interagency Coordi nating Council (Council) that meets the requirements of subpart G of 34 CFR Part 303. ( 34 CFR §303.125)

19. The Statewide system includes policies and procedures to ensure, consistent with 34 CFR §§303.13(a)(8) (early intervention services), 303 .26 (natural environments), and 303.344(d)(1)(ii) (content of an IFSP), that early intervention services for infants and toddlers with disabilities are provided

-- (a) To the maximum extent appropriate, in natural environments; and (b) In settings other th an the natural environment that are most appropriate, as determined by the parent and the IFSP Team, only when early intervention services cannot be achieved satisfactorily in a natural environment. (34 CFR §303.126)

20. The Statewide system ensures t hat Federal funds made available to the State under section 643 of the Act will be expended in accordance with the provisions of 34 CFR Part 303, including § §303.500 and 303.501. (34 CFR §303.221)

21. The Statewide system will comply with the requirements in §§303. 510 and 303. 511 in subpart F of this part . (34 CFR §303.222)

22. The Statewide system ensures that

-- (a) The control of funds provided under 34 CFR Part 303, and title to property acquired with those funds, will be in a public agen cy for the__________________ State

Part C Annual State Application: FFY 201 5 Section II

- 22 OMB No. 1820

- 0550/Expiration Date: Check and enter date(s) as applicable **Subpart B**

**– As**  **surances** (20 U.S.C. 1434; 1435; and 1437(b); 34 CFR §§ 303.101

- 126; 303.220; 303.227)

**Yes** (Assurance is hereby provided.) **No**

(Assurance cannot be ensured. Provide date on which State will complete changes in order to provide assurance.) uses and purposes provided in 34 CFR Part 303; and

(b) A public agency will administer the funds and property. (34 CFR §303.223)

23. The Statewide system ensures that it will

-- (a) Make reports in the form and containing the information that the Secretary m ay

require; and (b) Keep records and afford access to those records as the Secretary ma y find necessary to ensure compliance with the requirements of 34 CFR Part 303, the correctness and verification of reports, and the proper disbursement of funds provided under 34 CFR Part 303. (34 CFR §303.224)

24. The Statewide system ensures that

– (a) Federal funds made available under section 643 of the Act to the State

– (1) Wi ll not be commingled with State funds; and (2) Wi ll be used so as to supplement the level of State and local funds expended for infants and toddlers with disabilities and their fa mi lies and in no case to supplant those State and local funds. (b) To meet the requirement in paragraph (a) of this section, the total am ount of State and local funds budgeted for expenditures in the current fiscal year for early intervention services for children eligible under this part and their families must be at least equal to the total amount of State and local funds actually expended for early intervention services for these children and their families in the most recent preceding fiscal year for which the information is available. Allowance may be made for

— (1) A decrease in the number of infants and toddlers who are eligible to receive early intervention services under this part; and (2) Unusually large amounts of funds expended for such long

-term purposes as the acquisition of equipment and the construction of facilities. (c) Requirement regarding indirect costs . (1) Except as provided in paragraph (c)(2) of this section, a lead agenc y under this part may not charge indirect costs to its Part C grant. (2) If approved by the lead agenc y’s cognizant Federal agency or by the Secretary, the lead agency must charge indirect costs through either

-- (i) A restricted indirect cost rate that meets the requirements in 34 CFR 76.560 through 76.569; or__________________ State

Part C Annual State Application: FFY 201 5 Section II

- 23 OMB No. 1820

- 0550/Expiration Date: Check and enter date(s) as applicable **Subpart B**

**– As**  **surances** (20 U.S.C. 1434; 1435; and 1437(b); 34 CFR §§ 303.101

- 126; 303.220; 303.227)

**Yes** (Assurance is hereby provided.) **No**

(Assurance cannot be ensured. Provide date on which State will complete changes in order to provide assurance.) (ii) A cost allocation plan that meets the non

- supplanting

requirements in paragraph (b) of this section and 34 CFR P art 76 of EDGAR. (3) In charging indirect costs under paragraph (c)(2)(i) and (c)(2)(ii) of this section, the lead agency may not charge rent, occupancy, or space maintenance costs directly to the Part C grant, unless those costs are specifically approved in advance by the Se cretary. (34 CFR §303.225)

25. The Statewide system ensures that fiscal control and fund accounting procedures will be adopted as necessary to ensure proper disbursement of, and accounting for, Federal funds paid under 34 CFR Part 303. (34 CFR § 303.226 )

26. The State ensures that policies and practices have been adopted to ensure that

-- (a) Traditionally underserved groups, including minority, low

- income, hom eless, and rural families and children with disabilities who are wards of the State, are mean ingfully involved in the planning and im plem entation of all the requirements of Part C; and (b) These families have access to culturally competent services within their local geographical areas. (34 CFR §303.227)

Assurance Regarding Optional Policy Enter 'NA’ in the cell to the left if this assurance is not applicable to your State. 27

. A State may adopt and has adopted a policy that includes making ongoing good

-faith efforts to recruit and hire appropriately and adequately trained personnel to prov ide early intervention services to infants and toddlers with disabilities, including, in a geographic area of the State where there is a shortage of such personnel, the most qualified individuals available who are making satisfactory progress toward com ple ting applicable course work necessary to meet the standards described in paragraphs (a) and (b) of this section. (34 CFR §303.119(d))__________________ State

Part C Annual State Application: FFY 201 5 Section II

- 24 OMB No. 1820

- 0550/Expiration Date: **C. Certifications**  The State Lead Agency is providing the following certifications:

**Yes**

1. The State certifies that ED Form 80

- 0013, Certification Regarding Lobbying , is on file

with the Secretary of Education. Wi th respect to the Certification Regarding Lobbying the State recertifies that no Federal appropriated funds have been paid or will be paid to any person for i nfluencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the making or renewal of Federal grants under this program; that the State shall complete and submit Standard Form

- LLL, "Disclosure Form to Report Lobbying," when required (34 CFR Part 82, Appendix B); and that the State Agenc y shall require the full certification, as set forth in 34 CFR Part 82, Appendix A, in the awa rd documents for all sub awards at all tiers.

2. The State certifies that it has met the certifications in the Education Department General Administrative Regulations (EDGAR) at 34 CFR §80.11 relating to State eligibility, authority and approval to submi t and carry out the provisions of its State application, and consistency of that application with State law are in place within the State.

3. The State certifies that the arrangements to establish financial responsibility for the provision of Part C service s among appropriate public agencies under §303.511 and the lead agency’s contracts with EIS providers regarding financial responsibility for the provision of Part C services meet the requirements in §§303.500 through 303.521 and are current as of the date of submission of the certification. ( 34 CFR §303.202)__________________ State

Part C Annual State Application: FFY 201 5 Section II

- 25 OMB No. 1820

- 0550/Expiration Date: **D. Statement**  I certify that the State of ________________________________ has provided the policies, procedures, me thods, descriptions, and assurances checked as 'yes' in Sections II.A and II.B and t he certifications required in Section II.C of this application. These provisions meet the requirements of Part C of the Individuals with Disabilities Education Act as found in 20 U.S.C. 1431

- 1443 and the final regulations in 34 CFR Part 303. The State wi ll operate its Part C program in accordance with all of the required policies, procedures, methods, descriptions, assurances and certifications. If any policies, procedures, methods, descriptions, and assurances have been checked 'no', I certify that the S tate will operate throughout the period of this grant award consistent with the requirements of the IDEA as found in 20 U.S.C. 1431

- 1443 and the final regulations 34 CFR Part 303, and will make such changes to existing policies and procedures as are necess ary to bring those policies and procedures into com pliance with the requirements of the IDEA, as amended, as soon as possible, and not later than June 30, 201 6 . (34 CFR §76.104) I, the undersigned authorized official of the

_______________________________ ______________________________, (Name of State and official name of State lead agency)

am designated under Part C by the Governor of this State to submit this application for FFY 201 5 funds under Part C of the Individuals with Disabilities Education Act (I DEA).

Printed/T yped Name and Title of Authorized Representative of the State:
Signature: Date:__________________ State

Part C Annual State Application: FFY 201 5 Section III

- 1 OMB No. 1820

- 0550/Expiration Date: **Section III**

**A. Description of Use of Part C Funds for the Lead A** **gency** (Co mp letion of this Section, III.A is optional for SEAs

. ) Wh en com pleting this section include:

 Totals for the number of lead agency administrative positions, salaries and fringe benefits funded either 100 percent and/or less than 100 percent with Part C funds;

 A general description of the duties which the positions entail; and

 A subtotal of the amount. Identify any administrative positions for which less than 100% of the time is spent on Part C and, for each such position, indicate the percentage of time spent on Part C and the total amount of salary and fringe benefits included in the Part C application budget.

**Positions Funded**  **Number**

**of Positions**  **% of**

**Time Spent on**  **Part C Salaries** 

**& Fringe Benefits**  **Description of Duties**

100% funded with Part C Funds
< 100% funded with Part C Funds
**Subtotal of**  **amount under A**  **:**__________________ State

Part C Annual State Application: FFY 201 5 Section III

- 2 OMB No. 1820

- 0550/Expiration Date: **Section III ( Continued)**  **B. Ma**  **intenance and Implementation A ctivities for the Lead A** **gency** Wh en com pleting this section include:

 A description of the nature and scope of each major activity to be carried out under Part C in ma intaining and implementing the statewide syst em of early intervention services. Activities could include enhancing the Comprehensive System of Personnel Development, im plem enting child find strategies, or ensuring a timely, comprehensive, multidisciplinary evaluation for each child;

 The approximate am ount of funds to be spent for each activity; and

 A subtotal of the amount. (Add columns and rows as needed.)
**Ma jor A** **ctivity Part C Funds** 

**to be Spent Description of A** **ctivities**

**Subtotal of amount under B:** __________________ State

Part C Annual State Application: FFY 201 5 Section III

- 3 OMB No. 1820

- 0550/Expiration Date: **Section III (Continued) C.**  **Des cription of Use of Part C Funds for the Interagency Coordinating Council (ICC)**  **2**

 Wh en com pleting this section include: Totals for the number of ICC administrative positions, salaries and fringe benefits funded either 100 percent and/or less than 100 percen t with Part C funds;

 A general description of the duties which the positions entail; and

 A subtotal of the amount. Identify any administrative positions for which less than 100% of the time is spent on Part C and, for each such position, indicate the perc entage of time spent on Part C and the total amount of salary and fringe benefits included in the Part C application budget.

**Positions Funded**  **Number**

**of Positions**  **% of**

**Time Spent on**  **Part C Am**  **ount**

**of Salaries**  **& Fringe Benefits**  **Description of Duties**

100% fun ded with Part C Funds
< 100% funded with Part C Funds
**Subtotal of**  **amount under C:** 

2 Federal Part C funds used to support the SICC must meet the requirements of 34 CFR §303.603

.__________________ State

Part C Annual State Application: FFY 201 5 Section III

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- 0550/Expiration Date: **Section III (Continued) D.**  **Ma intenance and Implementation A** **ctivities for the Interagency Coordinating Council (ICC)** Wh en com pleting this section include:

 A de scription of the nature and scope of each major activity to be carried out under Part C in ma intaining and implementing the statewide system of early intervention services. Activities could include coordinating child find identification efforts, ensuring the timely provision and payme nt of early intervention services to eligible children and their families, advising on early childhood transition, support for the ICC (travel), or other implementation and development activities of the SICC;

 The approximate a mo unt of funds to be spent for each activity; and

 A subtotal of the amount. (Add columns and rows as needed.)
**Ma jor A** **ctivity Part C Funds** 

**to be Spent Description of A** **ctivities**

**Subtotal of amount under D:** __________________ State

Part C Annual State Application: FFY 201 5 Section III

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- 0550/Expiration Date: **Section III (Continued) E.**  **Dire ct Services (Funded by Part C Federal Dollars)** 

 Wh en com pleting this section include a description of any direct early intervention service that the State lead agency expects to provide to eligible children and their families with funds under Part C, and th e approximate amount for each direct service (States must disaggregate by service the approximate amount of funds expected to be expended for each direct service)

.

**Description of Each**  **Direct Early Intervention Service Ap**  **proximate A mount of Part C**  **Funds to be Spent on**  **Each Direct**

**Service**

**Subtotal of amount under E:**__________________ State

Part C Annual State Application: FFY 201 5 Section III

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- 0550/Expiration Date: **Section III (Continued)**

**F. Description of Optional Use of Part C Funds** If the State uses Part C funds for initiating, expanding, or improving collaborative efforts related to a t

- risk infants and toddlers , the application must include :

 The name of the ma jor activity ;

 The approximate amount of funds to be spent; and

 A description of the activit ies

. Provide subtotal of amount. (Add columns and rows as needed.)

**Ma jor**  **Activity Par**  **t C Funds to be Spent**  **Description of A ctivities** 

**Subtotal of amount under F:** __________________ State

Part C Annual State Application: FFY 201 5 Section III

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- 0550/Expiration Date: **Section III (Continued)**

**G**

**. Activities by Other A** **gencies** If other State or local public agencies are to receive a portion of the Federal funds under Part C, the Application must include:

 The name of each public agency expected to receive funds;

 The approximate amount of funds each public agenc y will receive; and

 A summary of the purposes for which the funds will be used. Provide subtotal of amount. ( Add columns and rows as needed.) **Ag ency Receiving Funds**  **Am ount of Funds**  **Purpose**

**Subtotal of amount under G**  **:**__________________ State

Part C Annual State Application: FFY 201 5 Section III

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- 0550/Expiration Date: **Section III (Continued) H.**  **Totals**
Enter the subtotal amounts for Sub Sections A

- G found in Section III and any indirect costs c harged as specified in Section IV.B. The sub total amounts (Rows 1

- 8) should total the estimated grant application amount. (A State may apply for less than the full estimated allotted amount.)
Enter the subtotal amounts for Sub Sections A

- G found in Sect ion III of this application.

**Row No. Section**  **Am ount** 

1. III.A. $

2. III.B. $

3. III.C. $

4. III.D. $

5. III.E. $

6. III.F. $

7. III G. $ Enter any Indirect Costs Charged (See Section IV.B of this application.)

8

. IV.B $

**Total** (Rows 1

- 8 ) $__________________ State

Part C Annual State Application: FFY 201 5 Section IV

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- 0550/Expiration Date: **Section IV**

**A. System of Payments / Use of Insurance / Program Income** 
The State _____ does (check as applicable) _____ does not (check as applicable) have a s ys tem of payme nts for Part C services under 34 CFR §§303.203(b)(1), 303.500(b), 303.520, and 303.5 21 which may

include use of public benefits or insurance, private insurance or family fees, such as a sliding scale. Any family fees are treated as 'program income' for purposes of 34 CFR § §80.25 and 303.520(e) and are not included in the State's determin ation of State and local expenditures for purposes of 20 U.S.C. 1437(b)(5)(B) and 34 CFR §303.225(a) and (b)

. Note: If the State has adopted new or has revised its existing policies and procedures regarding its system of payments, it must submit these ne w and/or revised policies and procedures under Item 3.a in Section II.A above. **B. Restricted Indirect Cost Rate/Cost A**  **llocation Plan Information** ( Note: To be completed if Lead Agency is not a State Educational Agency) Under 34 CFR §303.225(c), a lead age ncy may not charge indirect costs to its Part C grant unless the lead agency charges indirect costs through either

-- (i) A restricted indirect cost rate that meets the requirements in 34 CFR §§ 76.560 through 76.569; or (ii) A cost allocation plan that meets the non

supplanting requirements in paragraph (b) of this section and 34 CFR part 76 of EDGAR.
1. I f the lead agency is not a State educational agency (as well as any outlying areas that have the Department of Interior as its cognizant Federal agency, e ven if an SEA) check the applicable status below (more than one check mark may be necessary) and enclose appropriate documentation for this Federal Fiscal Year.

_____ The lead agency has a final restricted indirect cost rate or cost allocation plan that ha s been

approved by the State lead agenc y's cognizant Federal agency and is in effect for this Federal fiscal year (FFY) (ending on June 30, 201 6 ). (Attach a copy of the approved restricted indirect cost rate agreement or cost allocation plan.)

_____ The l ead agency has either a provisional or final restricted indirect cost rate or cost allocation

plan that expires or expired on _________ and the State is in the process of negotiating a new restricted indirect cost rate agreement or cost allocation plan tha t will be in effect for the period

____________________. 3 The State lead agency will continue to charge or bill the Part C grant using the provisional or previously approved final restricted indirect cost rate or cost allocation plan until a new rate or p lan is negotiated and approved by the State's cognizant Federal agency, at which point the State lead agenc y mu st m ak e appropriate adjustments for applicable FFYs. The State acknowledges that a final restricted indirect cost rate may result in an adjustme nt of the final audited expenditures allowable to be charged to the Part C grant and the Department's approval of this FFY Part C application with an expired or provisional restricted indirect cost rate does not constitute approval of that rate as the fina l rate for the lead agenc y for this FFY. W hen a final restricted indirect cost rate is approved, the lead agency mu st submit to OSEP: (1) a copy of the "final" restricted indirect cost rate agreement; and (2) details of adjustments made to past GAPS draw downs in light of the "final" rate. (Attach a copy of the previously approved restricted indirect cost rate agreement or cost allocation plan.)

_____ No indirect costs are charged to the Part C grant. The total amount of the Federal Part C grant

is used for allowable direct costs.

3 A "provisional" indirect cost rate is a temporary rate establish ed for a future prospective period of time to permit budgeting, obligations, and payment of funds by awarding agencies until such time as the actual indirect costs can be determined and a final rate is established for the applicable period; provisional rates are subject to adjustment by issuance of a "final" rate based on actual indirect costs incurred for the period (usually the organization's fiscal year).__________________ State

Part C Annual State Application: FFY 201 5 Section IV

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- 0550/Expiration Date: _____ Other, explanation attached.
2. Check if applicable

.

_____ Under 34 CFR §303.225( d ), the lead agenc y m ay not charge rent, occupanc y, or space ma intenance costs directly to the Part C grant, unless those costs are specifi cally approved in advance by the Secretary. The lead agency is requesting the Secretary’s approval to charge rent, occupancy or space maintenance costs either directly or indirectly to Part C FFY 201 4 funds. If checked, the lead agenc y m ust attach to thi s Application a description of the amount to be charged, all uses of the space, and the proposed method of charging.