Part C Annual State Application: FFY 2015 Page 1

(OMB No. 1820-0550/Expiration Date - )

SUPPORTING STATEMENT FOR PAPERWORK REDUCTION ACT SUBMISSION

ANNUAL STATE APPLICATION UNDER PART C OF THE INDIVIDUALS WITH DISABILITIES 

EDUCATION ACT AS AMENDED IN 2004, AND THE FINAL IDEA PART C REGULATIONS 

PUBLISHED ON SEPTEMBER 28, 2011 FOR FEDERAL FISCAL YEAR 2015

A. Justification

Q1. Explain the circumstances that make the collection of information necessary. Identify any legal or 

administrative requirements that necessitate the collection. Attach a copy of the appropriate 

section of each statute and regulation mandating or authorizing the collection of information.

A1. In order to be eligible for a grant under 20 U.S.C. 1433, a State must provide assurance to the 

Secretary that the State has adopted a policy that appropriate early intervention services are 

available to all infants and toddlers with disabilities in the State and their families, including Indian 

infants and toddlers with disabilities and their families residing on a reservation geographically 

located in the State, infants and toddlers with disabilities who are homeless children and their 

families, and has in effect a statewide system that meets the requirements of 20 U.S.C. 1435. 

Some policies, procedures, methods, and descriptions must be submitted to the Secretary.

This collection is conducted in a manner that is consistent with the guidelines in 5 CFR 1320.5.

Q2. Indicate how, by whom, and for what purpose the information is to be used. Except for a new 

collection, indicate the actual use the agency has made of the information received from the 

current collection.

A2. The Monitoring and State Improvement Planning Division (MSIPD), OSEP, uses this information 

to assist in making determinations of grant eligibility for each State. The information will be 

evaluated by Education Program Specialists to identify State and national needs for services 

required to meet early intervention requirements for children with disabilities (part C, 20 U.S.C. 

1434) and to provide to Congress and to the general public programmatic information, as 

appropriate.

Q3. Describe whether, and to what extent, the collection of information involves the use of automated, 

electronic, mechanical, or other technological collection techniques or forms of information 

technology, e.g. permitting electronic submission of responses, and the basis for the decision of 

adopting this means of collection. Also describe any consideration of using information 

technology to reduce burden.

A3. States continue to use computerized data bases to reduce the burden. States may submit any 

required information or revisions to the State application electronically.

Q4. Describe efforts to identify duplication. Show specifically why any similar information already 

available cannot be used or modified for use of the purposes described in Item 2 above.

A4. The Annual State Application was reviewed by the EDFacts team (Office of Planning, Evaluation 

and Policy Development) and the Regulatory Information Management Services (Office of 

Management). Information Collection 1820-0550 is the Part C State plan/application for funds.

At this time, EDFacts is not used to collect State plans/applications. EDFacts is not intended to 

collect this type of information since the information can not be aggregated or compared to similar 

information from other programs, but rather is used solely to establish eligibility for funds.

Q5. If the collection of information impacts small businesses or other small entities (Item 5 of OMB 

Form 83-I), describe any methods used to minimize burden.

A5. The information requested does not involve the collection of information from entities classified as 

small business.
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Q6. Describe the consequences to Federal program or policy activities if the collection is not 

conducted or is conducted less frequently, as well as any technical or legal obstacles to reducing 

burden.

A6. Items 1, 2, and 4 would not be accomplished unless directed by Federal statute.

Q7. Explain any special circumstances that would cause an information collection to be conducted in 

a manner:

 requiring respondents to report information to the agency more often than quarterly;

 requiring respondents to prepare a written response to a collection of information in fewer 

than 30 days after receipt of it;

 requiring respondents to submit more than an original and two copies of any document;

 requiring respondents to retain records, other than health, medical, government contract, 

grant-in-aid, or tax records for more than three years;

 in connection with a statistical survey, that is not designed to produce valid and reliable 

results that can be generalized to the universe of study;

 requiring the use of a statistical data classification that has not been reviewed and approved 

by OMB;

 that includes a pledge of confidentiality that is not supported by authority established in 

statute or regulation, that is not supported by disclosure and data security policies that are 

consistent with the pledge, or which unnecessarily impedes sharing of data with other 

agencies for compatible confidential use; or

 requiring respondents to submit proprietary trade secrets, or other confidential information 

unless the agency can demonstrate that it has instituted procedures to protect the 

information’s confidentiality to the extent permitted by law.

A7. There are no special circumstances that would cause an information collection to be conducted 

as described in the bulleted items. This collection is conducted in a manner that is consistent 

with the guidelines in 5 CFR 1320.5.

Q8. If applicable, provide a copy and identify the date and page number of 5 CFR 1320.8(d), soliciting 

comments on the information collection prior to submission to OMB. Summarize public comments 

received in response to that notice and describe actions taken by the agency in response to these 

comments. Specifically address comments received on cost and hour burden.

Describe efforts to consult with persons outside the agency to obtain their views on the availability 

of data, frequency of collection, the clarity of instruction and record keeping, disclosure, or 

reporting format (if any), and on the data elements to be recorded, disclosed, or reported.

Consultation with representatives of those from whom information is to be obtained or those who 

must compile records should occur at least once every 3 years—even if the collection of 

information activity is the same as in prior periods. There may be circumstances that may 

preclude consultation in a specific situation. These circumstances should be explained.

A8. Not applicable. IC 1820-0550 will go out for comment when placed on EDICS.

This collection is conducted consistent with the guidelines required by 5 CFR 1320.8(d).

9Q. Explain any decision to provide any payment or gift to respondents, other than re numeration of 

contractors or grantees.

9A. There are no payments or gifts to respondents other than the funds they receive under the 

formula mandated for this program.

10Q. Describe any assurance of confidentiality provided to respondents and the basis for the 

assurance in statute, regulations, or agency policy.

10A. The statute requires no assurance of confidentiality.
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11Q. Provide additional justification for any questions of a sensitive nature, such as sexual behavior 

and attitudes, religious beliefs, and other matters that are commonly considered private. This 

justification should include the reasons why the agency considers the questions necessary the 

specific uses to be made of the information, the explanation to be given to persons from whom 

the information is requested, and any steps to be taken to obtain their consent.

11A. There are no questions of a sensitive nature.

12Q. Provide estimates of the hour burden of the collection of information. The statement should:

 Indicate the number of respondents, frequency of response, annual hour burden, and an 

explanation of how the burden was estimated. Unless directed to do so, agencies should not 

conduct special surveys to obtain information on which to base hour burden estimates. 

Consultation with a sample (fewer than 10) of potential respondents is desirable. If the hour 

burden on respondents is expected to vary widely because of differences in activity, size, or 

complexity, show the range of estimated hour burden, and explain the reasons for the 

variance. Generally, estimates should not include burden hours for customary and usual 

business practices.

 If this request for approval covers more than one form, provide separate hour burden 

estimates for each form and aggregate the hour burdens in Item 13 of OMB Form 83-I.

 Provide estimates of annualized cost to respondents of the hour burdens for collections of 

information, identifying and using appropriate wage rate categories. The cost of contracting 

out or paying outside parties for information collection activities should not be included here. 

Instead, this cost should be included in Item 14.

12A. There are 56 respondents who, under PL 108-446, are required to submit the Part C Annual 

State Application if Federal funds are received. The data burden is expected to require an 

average of 10 hours per respondent. The burden estimate is: 56 respondents X 10 hours to 

submit the Annual State Application which equals an estimated total of 560 hours.

The estimated cost of preparing the State application is $12,320. The response time per 

response (estimated at 10 hours) is multiplied by the number of respondents (56) multiplied 

by the average hourly salary (estimated at $22).

13Q. Provide an estimate of the total annual cost burden to respondents or record keepers resulting 

from the collection of information. (Do not include the cost of any hour burden shown in Items 12 

and 14.)

 The cost estimate should be split into two components: (a) a total capital and start-up cost 

component (annualized over its expected useful life); and (b) a total operation and 

maintenance and purchase of services component. The estimates should take into account 

costs associated with generating, maintaining, and disclosing or providing the information. 

Include descriptions of methods used to estimate major cost factors including system and 

technology acquisition, expected useful life of capital equipment, the discount rates(s), and 

the time period over which costs will be incurred. Capital and start-up costs include, among 

other items, preparations for collecting information such as purchasing computers and 

software; monitoring, sampling, drilling and testing equipment; and record storage facilities.

 If cost estimates are expected to vary widely, agencies should present ranges of cost 

burdens and explain the reasons for the variance. The cost of contracting out information 

collection services should be a part of this cost burden estimate. In developing cost burden 

estimates, agencies may consult with a sample of respondents (fewer than 10), utilize the 60-

day pre-OMB submission public comment process and use existing economic or regulatory 

impact analysis associated with the rulemaking containing the information collection, as 

appropriate.

 Generally, estimates should not include purchases of equipment or services, or portions 

thereof, made: (1) prior to October 1, 1995, (2) to achieve regulatory compliance with 
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requirements not associated with the information collection, (3) for reasons other than to 

provide information or keep records for the government, or (4) as part of customary and usual 

business or private practices.

13A. There are no start-up costs, or costs in addition to those described in item 12. There are no 

anticipated costs for operation, maintenance, or purchase of services that are imposed on States 

by these requirements, other than those noted above.

14Q. Provide estimates of annualized cost to the Federal government. Also, provide a description of 

the method used to estimate cost, which should include quantification of hours, operational 

expenses (such as equipment, overhead, printing, and support staff), and any other expense that 

would not have been incurred without this collection of information. Agencies also may aggregate 

cost estimates from Items 12, 13, and 14 in a single table.

14A. The estimated cost to the Federal Government is the staff time to review and analyze the 

applications. It is estimated that it will take 3 hours of staff time to review each of the 56 

applications, which equals 168 hours. The 168 hours is multiplied by the average hourly rate of 

pay for each reviewer ($36), to equal an estimated cost to the Federal Government of $6,048. 

The overall cost to the Federal Government will be greatly reduced since States are now required 

to submit a combination of policies, procedures, methods, description, and assurances.

15Q. Explain the reasons for any program changes or adjustments reported in Items 12 or 14 of the 

OMB Form 83-I.

15A. There have been no program changes or adjustments.

16Q. For collections of information whose results will be published, outline plans for tabulation and 

publication. Address any complex analytical techniques that will be used. Provide the time 

schedule for the entire project, including beginning and ending dates of the collection of 

information, completion of report, publication dates, and other actions.

16A. The information in the State application is not published.

17Q. If seeking approval to not display the expiration date for OMB approval of the information 

collection, explain the reasons that display would be inappropriate.

17A. There is no request to ask for approval not to display the expiration date.

18Q. Explain each exception to the certification statement identified in Item 19, “Certification for 

Paperwork Reduction Act Submissions,” of OMB Form 83-I.

18A. There are no proposed exceptions to the certifications.

B. Collections of Information Employing Statistical Methods

This collection does not require that statistical methodology be employed.