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TABLE 3 

REPORT ON INFANTS AND TODDLERS EXITING PART C1

2013 - 2014

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 50.3 hours per State response, including time for 

reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and 

completing and reviewing the collection of information. The obligation to respond to this collection is 

required to obtain or retain a benefit (P.L. 108.446 Section 618). Send comments regarding the burden 

estimate or any other aspect of this collection of information, including suggestions for reducing this 

burden, to the U.S. Department of Education, 400 Maryland Ave., SW, Washington, DC 20202-4536 or 

email ICDocketMgr@ed.gov and reference the OMB Control Number 1820-0557. Note: Please do not 

return the completed Report on Infants and Toddlers Exiting Part C form to this address.

All States must submit these data via the IDEA Part C Exiting survey in the EDFacts online survey 

tool, EMAPS.

Instructions

Authorization: 20 U.S.C. 1418(a)(1)(C) and (a)(3)

Due Date: November 5, 2014

Sampling Allowed: No

General Instructions

1. Report the number of infants and toddlers with disabilities who, during the 12-month reporting 

period, either no longer received services under Part C prior to age three or reached age three, 

and for each child, report by race/ethnicity, gender, and reason that services are no longer 

received.

2. States should report counts for a 12-month reporting period. The State can determine the 12-

month reporting period of data collection. This 12-month window (reporting period) should 

be the same for each annual report of these data. States must indicate on the form the specific 

12-month period the State used for reporting. If the State needs to revise the dates for its 12-

month reporting period, it should notify OSEP in advance of any change in the State-identified 

reporting period. 

3. Include on the form any child who was under age three and had an active individualized 

family service plan (IFSP) in place at some point during the reporting period and at the end of 

 

1 Note that in addition to capturing infants and toddlers exiting the Part C program, this form also requires reporting 

on those children with disabilities who may continue to receive services under Part C under 20 U.S.C. 1435(c).
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the reporting period either was no longer receiving services under Part C or had reached his or 

her third birthday.

4. The infants and toddlers with disabilities represented on this form must be an unduplicated 

count; no child should be counted more than once during the 12-month reporting period. If a 

child is identified as no longer receiving services under Part C more than once during the 

reporting period, report the reason that services are no longer being received based on the last 

time the child exited (i.e., report the child in the category that corresponds to the most recent 

reason for no longer receiving services under Part C).

5. Do NOT report a child as exiting Part C if:

 the child had turned age three at the start of the reporting period;

2

or 

 services were temporarily interrupted and subsequently resumed before the end of the 

reporting period; or 

 the child was under age three at the end of the reporting period and had an active 

IFSP, even if services were intermittently stopped during the reporting period.

6. If your State serves infants and toddlers who are at risk of having substantial delays if early

intervention services are not provided as specified under 20 U.S.C. 1432(5)(B)(i), include 

these children in the table counts if they were no longer receiving service under Part C or 

reached age three during the reporting period.

7. All reported totals must equal the sum of the subsequent rows or columns. 

8. For each reason that a child is no longer receiving services under Part C, the total number of 

children reported by race/ethnicity in Section A must equal the total number of children 

reported for that exit reason by gender in Section B. 

9. STATES SHOULD NOT PROVIDE PERCENTAGES IN SECTIONS A AND B. THESE 

WILL BE CALCULATED BY EDFACTS ONLINE SURVEY TOOL, EMAPS.

10. In providing data for this collection, the State is to submit complete and unsuppressed data.

Specific Row (Reason for No Longer Receiving Services) Instructions

Using the categories below, report each infant or toddler with a disability, as defined in 20 U.S.C. 1432(5),

who reached age three or were no longer receiving services under Part C within this 12-month reporting 

period according to the most recent reason for no longer receiving services. 

There are three major groupings of reasons: Program Completion (category 1), Exit at Age Three

(categories 2 through 6), and Not Receiving Services (categories 7 through 10). The categories within 

each of these groupings are defined below. 

 

2 These children should have been counted in the previous reporting period under “Exit at Age Three”.
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A. Program Completion

1. No longer eligible for Part C prior to reaching age three. Include all children who within 

this 12-month reporting period, have exited Part C before age three because they are no 

longer eligible under IDEA, Part C.

B. Exit at Age Three

2. Part B eligible, exiting Part C. Include all children determined to be eligible for Part B 

during the reporting period and who exited (or will soon exit) Part C. This includes 

children who receive Part B services in conjunction with Head Start.

3. Part B eligible, continuing in Part C. Include all children determined to be eligible for 

Part B, and whose parents were offered and consented to have their child remain in Part C 

under 20 USC 1432(5)(B)(ii) and 1435(c). The Part B eligible, continuing in Part C 

category may ONLY be used by a state whose application for IDEA Part C funds includes 

a policy under which parents of children with disabilities who were eligible for services 

under IDEA Section 619 and previously received services under Part C may continue to 

receive early intervention services under Part C beyond age three. States that do not offer 

this option under 20 USC 1432(5)(B)(ii) and 1435(c) may NOT report children in this 

category. 

4. Not eligible for Part B, exit with referrals to other programs. Include all children who

reached age three, were evaluated and determined not eligible for Part B, and were 

referred to other programs, which may include preschool learning centers, Head Start (but 

not receiving Part B services), and child care centers, and/or were referred for other 

services, which may include health and nutrition services, such as WIC.

5. Not eligible for Part B, exit with no referrals. Include all children who reached age three, 

were evaluated and determined not eligible for Part B, but were not referred to other 

programs. 

6. Part B eligibility not determined. Include all children who reached their third birthday and 

their Part B eligibility was not determined during this reporting period. This category

includes children who were referred for Part B evaluation, but for whom the eligibility

determination has not yet been made or reported or children for whom parents did not 

consent to transition planning. Include in this category any child who reached age three, 

and who has not been reported in categories 2-5 above. 

C. Not Receiving Services

7. Deceased. Include all children who died before their third birthday, even if their death 

occurred at the age of exit. Include only children who died during the reporting period.

8. Moved out of State. Include all children who moved out of state before their third 

birthday. Include only children who moved during the reporting period. Do not report a 

child who moved within State (i.e., from one program to another) if services are known to 

be continuing. 
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9. Withdrawal by parent (or guardian). Include all children under the age of three whose 

parents declined all services (including service coordination services) after an IFSP was in 

place, or declined to consent to Part C services on the IFSP and provided written or verbal 

indication of withdrawal from Part C services.

10. Attempts to contact the parent and/or child were unsuccessful. Include all children, under 

the age of three, who had an active IFSP, and for whom Part C personnel have been 

unable to provide early intervention services either due to lack of response from the parent 

or family, or inability to contact or locate the family or child after repeated, documented 

attempts. Include in this category any child who was no longer receiving services under 

Part C before reaching age three, and who has not been reported in categories 7-9 above.

Specific Column Instructions for Section A: Race/Ethnicity

STATES MUST REPORT THE RACE/ETHNICITY OF THE CHILD, NOT THE FAMILY. FOR 

EACH OF THE RACE/ETHNICITY CATEGORIES, REPORT AN UNDUPLICATED COUNT OF 

CHILDREN EXITING.

In October 2007, the Department of Education published its Final Guidance on Maintaining, Collecting 

and Reporting Racial and Ethnic Data to the U.S. Department of Education in the Federal Register (Vol. 

72, No. 202, available at http://www.gpoaccess.gov/nara/index.html), referred to in these instructions as 

the new guidance. The procedures for collecting, aggregating, and reporting race and ethnicity, as 

described in the new guidance, must be implemented for the report of the 2013-14 Exiting data. 

States should report all children with disabilities according to the seven categories listed below. The 

following definitions of the seven categories for aggregate report of race/ethnicity have been adapted from 

definitions appearing in the new guidance.
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Hispanic/Latino A person of Cuban, Mexican, Puerto Rican, South or Central 

American, or other Spanish culture or origin, regardless of race. Refers 

to Hispanic and/or Latino. 

American Indian or Alaska 

Native

A person having origins in any of the original peoples of North and 

South America (including Central America) and who maintains tribal 

affiliation or community attachment. (Does not include persons of 

Hispanic/Latino ethnicity.)

Asian A person having origins in any of the original peoples of the Far East, 

Southeast Asia, or the Indian subcontinent. This includes, for example, 

Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the 

Philippine Islands, Thailand, and Vietnam. (Does not include persons 

of Hispanic/Latino ethnicity.)

Black or African American A person having origins in any of the Black racial groups of Africa. 

(Does not include persons of Hispanic/Latino ethnicity.)

Native Hawaiian or Other 

Pacific Islander

A person having origins in any of the original peoples of Hawaii, 

Guam, Samoa, or other Pacific Islands. (Does not include persons of 

Hispanic/Latino ethnicity.)

White A person having origins in any of the original peoples of Europe, the 

Middle East, or North Africa. (Does not include persons of 

Hispanic/Latino ethnicity.)

Two or more races A person having origins in two or more of the five race categories listed 

immediately above. (Does not include persons of Hispanic/Latino 

ethnicity.)

Total The unduplicated total across the seven (7) race/ethnicity designations.

Note that each child should be reported in only one of the race/ethnicity categories, above.

Specific Column Instructions for Section B: Gender

1. Report the (unduplicated) number of children with an active IFSP in place at some point 

during the reporting period and at the end of the reporting period either was no longer 

receiving services under Part C or had reached his or her third birthday, according to the 

child’s gender and reason for no longer receiving services. 

2. The total numbers of children reported in Section B should equal the total numbers of children 

reported in Section A by reason for no longer receiving services.
U.S. DEPARTMENT OF EDUCATION TABLE 3 PAGE 1 OF 4

OFFICE OF SPECIAL EDUCATION

AND REHABILITATIVE SERVICES REPORT ON INFANTS AND TODDLERS EXITING PART C PROGRAMS OMB NO.: 1820-0557

OFFICE OF SPECIAL EDUCATION

PROGRAMS 2013-2014 FORM EXPIRES: xx/xx/xxxx

STATE:____________________________

SECTION A

12-Month Reporting Period (From MM/YY to MM/YY) to

REASON FOR EXIT TOTAL HISPANIC/ 

LATINO

AMERICAN 

INDIAN OR 

ALASKA 

NATIVE

ASIAN BLACK OR 

AFRICAN 

AMERICAN

NATIVE 

HAWAIIAN 

OR OTHER 

PACIFIC 

ISLANDER

WHITE

TWO OR 

MORE 

RACES

TOTAL NUMBER OF INFANTS AND TODDLERS EXITING BY 

RACE/ETHNICITY (ROWS 1-10)

PROGRAM COMPLETION

1. NO LONGER ELIGIBLE FOR PART C PRIOR TO 

REACHING AGE THREE

EXIT AT AGE THREE

2. PART B ELIGIBLE, EXITING PART C

3. PART B ELIGIBLE, CONTINUING IN PART C

4. NOT ELIGIBLE FOR PART B, EXIT WITH REFERRALS TO 

OTHER PROGRAMS

5. NOT ELIGIBLE FOR PART B, EXIT WITH NO REFERRALS

6. PART B ELIGIBILITY NOT DETERMINED

NOT RECEIVING SERVICES

7. DECEASED

8. MOVED OUT OF STATE

9. WITHDRAWAL BY PARENT (OR GUARDIAN)

10. ATTEMPTS TO CONTACT UNSUCCESSFUL
U.S. DEPARTMENT OF EDUCATION TABLE 3 (CONTINUED) PAGE 2 OF 4

OFFICE OF SPECIAL EDUCATION

AND REHABILITATIVE SERVICES REPORT ON INFANTS AND TODDLERS EXITING PART C PROGRAMS OMB NO.: 1820-0557

OFFICE OF SPECIAL EDUCATION

PROGRAMS 2013-2014 FORM EXPIRES: xx/xx/xxxx

SECTION A : PERCENT*

REASON FOR EXIT TOTAL HISPANIC/ 

LATINO

AMERICAN 

INDIAN OR 

ALASKA 

NATIVE

ASIAN BLACK OR 

AFRICAN 

AMERICAN

NATIVE 

HAWAIIAN 

OR OTHER 

PACIFIC 

ISLANDER

WHITE

TWO OR 

MORE 

RACES

PERCENT* EXITING BY RACE/ETHNICITY (ROWS 1-10) 100%

PROGRAM COMPLETION

1. NO LONGER ELIGIBLE FOR PART C PRIOR TO 

REACHING AGE THREE 100%

EXIT AT AGE THREE

2. PART B ELIGIBLE, EXITING PART C 100%

3. PART B ELIGIBLE, CONTINUING IN PART C 100%

4. NOT ELIGIBLE FOR PART B, EXIT WITH REFERRALS TO 

OTHER PROGRAMS 100%

5. NOT ELIGIBLE FOR PART B, EXIT WITH NO REFERRALS 100%

6. PART B ELIGIBILITY NOT DETERMINED 100%

NOT RECEIVING SERVICES

7. DECEASED 100%

8. MOVED OUT OF STATE 100%

9. WITHDRAWAL BY PARENT (OR GUARDIAN) 100%

10. ATTEMPTS TO CONTACT UNSUCCESSFUL 100%

* STATES SHOULD NOT PROVIDE PERCENTAGES IN THIS SECTION, AS THEY WILL BE CALCULATED AFTER THE COUNTS ARE SUBMITTED. 

.
.

U.S. DEPARTMENT OF EDUCATION TABLE 3 (CONTINUED) PAGE 3 OF 4

OFFICE OF SPECIAL EDUCATION

AND REHABILITATIVE SERVICES REPORT ON INFANTS AND TODDLERS EXITING PART C PROGRAMS OMB NO.: 1820-0557

OFFICE OF SPECIAL EDUCATION

PROGRAMS 2013-2014 FORM EXPIRES: xx/xx/xxxx

STATE:____________________________

SECTION B

REASON FOR EXIT TOTAL MALE FEMALE

TOTAL NUMBER OF INFANTS AND TODDLERS EXITING BY 

GENDER (ROWS 1-10)

PROGRAM COMPLETION

1. NO LONGER ELIGIBLE FOR PART C PRIOR TO 

REACHING AGE THREE

EXIT AT AGE THREE

2. PART B ELIGIBLE, EXITING PART C

3. PART B ELIGIBLE, CONTINUING IN PART C

4. NOT ELIGIBLE FOR PART B, EXIT WITH REFERRALS TO 

OTHER PROGRAMS

5. NOT ELIGIBLE FOR PART B, EXIT WITH NO REFERRALS

6. PART B ELIGIBILITY NOT DETERMINED

NOT RECEIVING SERVICES

7. DECEASED

8. MOVED OUT OF STATE

9. WITHDRAWAL BY PARENT (OR GUARDIAN)

10. ATTEMPTS TO CONTACT UNSUCCESSFUL
U.S. DEPARTMENT OF EDUCATION TABLE 3 (CONTINUED) PAGE 4 OF 4

OFFICE OF SPECIAL EDUCATION

AND REHABILITATIVE SERVICES REPORT ON INFANTS AND TODDLERS EXITING PART C PROGRAMS OMB NO.: 1820-0557

OFFICE OF SPECIAL EDUCATION

PROGRAMS 2013-2014 FORM EXPIRES: xx/xx/xxxx

SECTION B: PERCENT*

REASON FOR EXIT TOTAL MALE FEMALE

PERCENT* EXITING BY GENDER (ROWS 1-10) 100%

PROGRAM COMPLETION

1. NO LONGER ELIGIBLE FOR PART C PRIOR TO 

REACHING AGE THREE

100%

EXIT AT AGE THREE

2. PART B ELIGIBLE, EXITING PART C 100%

3. PART B ELIGIBLE, CONTINUING IN PART C 100%

4. NOT ELIGIBLE FOR PART B, EXIT WITH REFERRALS TO 

OTHER PROGRAMS

100%

5. NOT ELIGIBLE FOR PART B, EXIT WITH NO REFERRALS 100%

6. PART B ELIGIBILITY NOT DETERMINED 100%

NOT RECEIVING SERVICES

7. DECEASED 100%

8. MOVED OUT OF STATE 100%

9. WITHDRAWAL BY PARENT (OR GUARDIAN) 100%

10. ATTEMPTS TO CONTACT UNSUCCESSFUL 100%

* STATES SHOULD NOT PROVIDE PERCENTAGES IN THIS SECTION, AS THEY WILL BE CALCULATED AFTER THE COUNTS ARE SUBMITTED.