Table 1-RE7 (for reporting race/ethnicity according to n

Page 4 of 4

TABLE 1 – RE7 (for reporting race/ethnicity according to New 10/2007 Guidance)

REPORT OF CHILDREN WITH DISABILITIES

RECEIVING SPECIAL EDUCATION

UNDER PART B OF THE INDIVIDUALS WITH

DISABILITIES EDUCATION ACT, AS AMENDED

Specific State-Designated Date between October 1 and December 1 of 2010

Paperwork Burden Statement

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 1820-0043. The time required to complete this information collection is estimated to average 1.9 hours per LEA and 7.4 hours per SEA response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, D.C. 20202. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: Office of Special Education Programs, U.S. Department of Education, 400 Maryland Avenue, SW, Washington, D.C. 20202.

For States that have been approved for EDFacts-only submission, the State EDFacts Coordinators will submit these data as specified by OSEP via the EDFacts system. All other States must submit electronic versions of the completed data forms to OSEP’s data contractor at [email protected]. OSEP will provide electronic Data Transmission Spreadsheets (DTS) in Microsoft Excel format to facilitate this process. States that are approved to submit these data through EDFacts only are not required to use the DTS. Nevertheless, all States will receive the DTS as a courtesy as they may assist in preparing the data for submission. All States must submit the Certification Form directly to OSEP.

Authorization: P.L. 108-446, §§ 618(a)(1)(A)(i) and 618(a)(3); 34 CFR §§300.640, 300.641, 300.643, 300.644, 300.645

Due Date: February 2, 2011

Sampling Allowed: No

Send Certification Form to: Alexa Posny, Acting Director

Office of Special Education Programs

Part B Data Reports

Program Support Services Group

Mail stop 2600

550 12th Street, S.W.

Washington, D.C. 20202

Attn: Cheryl Broady

General Instructions

1. Report the number of children with disabilities receiving special education and related services according to an individualized education program or service plan¹ in place on the count date. This must be an unduplicated count; each child is counted once and only once.

2. All totals must represent the sum of the preceding rows or columns. Report zeros (0) where there are no children to report in a data cell.

3. The count is to be taken on a state-designated date between October 1, 2010 and December 1, 2010 (inclusive), and that date should remain consistent each year.² Children ages 3-5 and 6-21 must be reported according to their disability category and discrete age year based upon each child's age as of the data collection date. Children ages 3-5 and ages 6-21 should be reported by their race/ethnicity and disability category.

4. If a child has more than one primary disability, the child must be reported accorded to the following procedure:

• If a child has only two primary disabilities and those disabilities are deafness and blindness, and the child is not reported as having a developmental delay, that child must be reported under the category “deaf-blindness.”

• A child who has more than one primary disability and is not reported as having deaf-blindness or as having a developmental delay must be reported under the category “multiple disabilities.”

5. The reporting of data on developmental delay is optional. Only children ages 3 through 9 may be reported in the developmental delay disability category and then only in States with the diagnostic instruments and procedures to measure delays in physical, cognitive, communication, social or emotional, or adaptive development. States must have defined and established eligibility criteria for developmental delay in order to report children in this category. Although Federal law does not require that States and LEAs categorize children according to developmental delay, if this category is required by State law, States are expected to report these children in the developmental delay category.

6.

7. States should not provide percentages in sections B through E, as they will be calculated after the counts are submitted.

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

Specific Instructions

Section B. Discrete Age by Disability of Children Ages 3-5 Receiving Special Education

In Section B, indicate for each discrete age and type of disability the number of children receiving special education and related services according to an individualized education program. States are required to complete the entire table, providing data for discrete ages, age groupings, and disability categories.

Sections C and E. Race/Ethnicity by Disability of Children Receiving Special Education

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 by no later than the report of the 2010 Child Count data. When implementing the new guidance, States must do so at the beginning of the relevant reporting period and must apply the guidance consistently to ALL data reported within that period.

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.

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 the 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.

Section C. Race/Ethnicity by Disability of Children Ages 3 – 5 Receiving Special Education

Report the total number of students with disabilities ages 3-5 by disability condition and race/ethnicity category. Enter an unduplicated number of all children with disabilities ages 3-5 by race/ethnicity category. Use the race/ethnicity categories and procedures described for Sections C and E, above. Note that students may only be reported in one race/ ethnicity category.

Section D. Discrete Age by Disability of Children Ages 6-21 Receiving Special Education

Indicate for each age category and type of disability the number of children receiving special education and related services according to an individualized educational program. States are required to complete the entire table, providing data for discrete ages, age groupings, and disability categories.

Section E. Race/Ethnicity by Disability of Children Ages 6-21 Receiving Special Education

Report the total number of students with disabilities ages 6-21 by disability condition and race/ethnicity categories. Use the race/ethnicity categories and procedures described for Sections C and E, above. Note that students may only be reported in one race/ ethnicity category.

Section F. Certification

Paper copy of the Child Count certification (page 8 of 8 of the attached Table) must be signed by the Chief State School Officer or the individual authorized by the State to certify these counts. This procedure applies both to States that are reporting data tables directly to OSEP and States that have been approved for EDFacts-only data submission procedures.

Please note: To reduce data burden, the total number of children in each gender and Limited English Proficiency status category are included on the Educational Environments report (Table 3). These data are not reported on Table 1.

U.S. DEPARTMENT OF EDUCATION OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES OFFICE OF SPECIAL EDUCATION PROGRAMS	TABLE 1 REPORT OF CHILDREN WITH DISABILITIES RECEIVING SPECIAL EDUCATION PART B, INDIVIDUALS WITH DISABILITIES EDUCATION ACT, AS AMENDED	PAGE 1 OF 8 OMB NO.: 1820-0043 FORM EXPIRES: 10/31/2012
	2010

STATE: ____________________

SECTION A. DATA COLLECTION DATE

COUNT DATE:

MONTH

DAY

YEAR

U.S. DEPARTMENT OF EDUCATION OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES OFFICE OF SPECIAL EDUCATION PROGRAMS	TABLE 1 REPORT OF CHILDREN WITH DISABILITIES RECEIVING SPECIAL EDUCATION PART B, INDIVIDUALS WITH DISABILITIES EDUCATION ACT, AS AMENDED	PAGE 2 OF 8 OMB NO.: 1820-0043 FORM EXPIRES: 10/31/2012
	2010

STATE: ____________________

SECTION B. DISCRETE AGE BY DISABILITY FOR CHILDREN AGES 3-5 RECEIVING SPECIAL EDUCATION

DISABILITY	AGE AS OF DATA COLLECTION DATE
	3	4	5	3-5	3-5 (PERCENT)1
MENTAL RETARDATION
HEARING IMPAIRMENTS
SPEECH OR LANGUAGE IMPAIRMENTS
VISUAL IMPAIRMENTS
EMOTIONAL DISTURBANCE
ORTHOPEDIC IMPAIRMENTS
OTHER HEALTH IMPAIRMENTS
SPECIFIC LEARNING DISABILITIES
DEAF-BLINDNESS
MULTIPLE DISABILITIES
AUTISM
TRAUMATIC BRAIN INJURY
DEVELOPMENTAL DELAY2
TOTAL: (Sum of all the above)					100%

¹ States should not provide percentages in this section, as they will be calculated after the counts are submitted.

² States must have defined and established eligibility criteria for developmental delay in order to use this category for reporting.

ED FORM: 869-5

U.S. DEPARTMENT OF EDUCATION OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES OFFICE OF SPECIAL EDUCATION PROGRAMS	TABLE 1 REPORT OF CHILDREN WITH DISABILITIES RECEIVING SPECIAL EDUCATION PART B, INDIVIDUALS WITH DISABILITIES EDUCATION ACT, AS AMENDED	PAGE 3 OF 8 OMB NO.: 1820-0043 FORM EXPIRES: 10/31/2012
	2010

STATE: ____________________

SECTION C RACE/ETHNICITY BY DISABILITY OF CHILDREN AGES 3-5 RECEIVING SPECIAL EDUCATION (2007 Reporting Guidelines)

DISABILITY	RACE/ETHNICITY
	HISPANIC/LATINO	AMERICAN INDIAN OR ALASKA NATIVE	ASIAN	BLACK OR AFRICAN AMERICAN	NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER	WHITE	TWO OR MORE RACES	TOTAL
MENTAL RETARDATION
HEARING IMPAIRMENTS
SPEECH OR LANGUAGE IMPAIRMENTS
VISUAL IMPAIRMENTS
EMOTIONAL DISTURBANCE
ORTHOPEDIC IMPAIRMENTS
OTHER HEALTH IMPAIRMENTS
SPECIFIC LEARNING DISABILITIES
DEAF-BLINDNESS
MULTIPLE DISABILITIES
AUTISM
TRAUMATIC BRAIN INJURY
DEVELOPMENTAL DELAY1
TOTAL: (Sum of all the above)
TOTAL: (PERCENT)2								100%

¹ States must have defined and established eligibility criteria for developmental delay in order to use this category for reporting.

² States should not provide percentages in this section, as they will be calculated after the counts are submitted.

ED FORM: 869-5

U.S. DEPARTMENT OF EDUCATION OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES OFFICE OF SPECIAL EDUCATION PROGRAMS	TABLE 1 REPORT OF CHILDREN WITH DISABILITIES RECEIVING SPECIAL EDUCATION PART B, INDIVIDUALS WITH DISABILITIES EDUCATION ACT, AS AMENDED	PAGE 4 OF 8 OMB NO.: 1820-0043 FORM EXPIRES: 10/31/2012
	2010

STATE: ____________________

SECTION D. DISCRETE AGE BY DISABILITY OF CHILDREN AGES 6-21 RECEIVING SPECIAL EDUCATION

DISABILITY	AGE AS OF DATA COLLECTION DATE
	6	7	8	9	10	11
MENTAL RETARDATION
HEARING IMPAIRMENTS
SPEECH OR LANGUAGE IMPAIRMENTS
VISUAL IMPAIRMENTS
EMOTIONAL DISTURBANCE
ORTHOPEDIC IMPAIRMENTS
OTHER HEALTH IMPAIRMENTS
SPECIFIC LEARNING DISABILITIES
DEAF-BLINDNESS
MULTIPLE DISABILITIES
AUTISM
TRAUMATIC BRAIN INJURY
DEVELOPMENTAL DELAY1
TOTAL: (Sum of all the above)

¹ States must have defined and established eligibility criteria for developmental delay in order to use this category for reporting.

ED FORM: 869-5

U.S. DEPARTMENT OF EDUCATION OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES OFFICE OF SPECIAL EDUCATION PROGRAMS	TABLE 1 REPORT OF CHILDREN WITH DISABILITIES RECEIVING SPECIAL EDUCATION PART B, INDIVIDUALS WITH DISABILITIES EDUCATION ACT, AS AMENDED	PAGE 5 OF 8 OMB NO.: 1820-0043 FORM EXPIRES: 10/31/2012
	2010

STATE: ____________________

SECTION D (CONTINUED)

DISABILITY	AGE AS OF DATA COLLECTION DATE
	12	13	14	15	16	17
MENTAL RETARDATION
HEARING IMPAIRMENTS
SPEECH OR LANGUAGE IMPAIRMENTS
VISUAL IMPAIRMENTS
EMOTIONAL DISTURBANCE
ORTHOPEDIC IMPAIRMENTS
OTHER HEALTH IMPAIRMENTS
SPECIFIC LEARNING DISABILITIES
DEAF-BLINDNESS
MULTIPLE DISABILITIES
AUTISM
TRAUMATIC BRAIN INJURY
DEVELOPMENTAL DELAY
TOTAL: (Sum of all the above)

ED FORM: 869-5

U.S. DEPARTMENT OF EDUCATION OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES OFFICE OF SPECIAL EDUCATION PROGRAMS	TABLE 1 REPORT OF CHILDREN WITH DISABILITIES RECEIVING SPECIAL EDUCATION PART B, INDIVIDUALS WITH DISABILITIES EDUCATION ACT, AS AMENDED	PAGE 6 OF 8 OMB NO.: 1820-0043 FORM EXPIRES: 10/31/2012
	2010

STATE: ____________________

SECTION D (CONTINUED)

DISABILITY	AGE AS OF DATA COLLECTION DATE
	18	19	20	21	6-21 (NUMBER)	6-21 (PERCENT)1
MENTAL RETARDATION
HEARING IMPAIRMENTS
SPEECH OR LANGUAGE IMPAIRMENTS
VISUAL IMPAIRMENTS
EMOTIONAL DISTURBANCE
ORTHOPEDIC IMPAIRMENTS
OTHER HEALTH IMPAIRMENTS
SPECIFIC LEARNING DISABILITIES
DEAF-BLINDNESS
MULTIPLE DISABILITIES
AUTISM
TRAUMATIC BRAIN INJURY
DEVELOPMENTAL DELAY2
TOTAL: (Sum of all the above)						100% 100%

¹ States should not provide percentages in this section, as they will be calculated after the counts are submitted.

² States must have defined and established eligibility criteria for developmental delay in order to use this category for reporting.

ED FORM: 869-5

U.S. DEPARTMENT OF EDUCATION OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES OFFICE OF SPECIAL EDUCATION PROGRAMS	TABLE 1 REPORT OF CHILDREN WITH DISABILITIES RECEIVING SPECIAL EDUCATION PART B, INDIVIDUALS WITH DISABILITIES EDUCATION ACT, AS AMENDED	PAGE 7 OF 8 OMB NO.: 1820-0043 FORM EXPIRES: 10/31/2012
	2010

STATE: ____________________

SECTION E. RACE/ETHNICITY BY DISABILITY OF CHILDREN AGES 6-21 RECEIVING SPECIAL EDUCATION (2007 Reporting Guidelines)

DISABILITY	RACE/ETHNICITY
	HISPANIC/LATINO	AMERICAN INDIAN OR ALASKA NATIVE	ASIAN	BLACK OR AFRICAN AMERICAN	NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER	WHITE	TWO OR MORE RACES	TOTAL
MENTAL RETARDATION
HEARING IMPAIRMENTS
SPEECH OR LANGUAGE IMPAIRMENTS
VISUAL IMPAIRMENTS
EMOTIONAL DISTURBANCE
ORTHOPEDIC IMPAIRMENTS
OTHER HEALTH IMPAIRMENTS
SPECIFIC LEARNING DISABILITIES
DEAF-BLINDNESS
MULTIPLE DISABILITIES
AUTISM
TRAUMATIC BRAIN INJURY
DEVELOPMENTAL DELAY1
TOTAL: (Sum of all the above)
TOTAL: (PERCENT)2								100%

¹ States must have defined and established eligibility criteria for developmental delay in order to use this category for reporting.

² States should not provide percentages in this section, as they will be calculated after the counts are submitted.

ED FORM: 869-5

U.S. DEPARTMENT OF EDUCATION OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES OFFICE OF SPECIAL EDUCATION PROGRAMS	TABLE 1 REPORT OF CHILDREN WITH DISABILITIES RECEIVING SPECIAL EDUCATION PART B, INDIVIDUALS WITH DISABILITIES EDUCATION ACT, AS AMENDED	PAGE 8 OF 8 OMB NO.: 1820-0043 FORM EXPIRES: 10/31/2012
	2010

REPORT DUE NO LATER THAN FEBRUARY 1

STATE: ____________________

SECTION F. CERTIFICATION

I CERTIFY that these data represent an accurate and unduplicated count of children with disabilities receiving special education and related services according to an Individualized Education Program on my State’s designated child count date, which falls between October 1 and December 1 of 2010.
AUTHORIZING OFFICIAL
NAME AND TITLE (TYPE OR PRINT)	SIGNATURE	DATE OF SIGNATURE

ED FORM: 869-5

1 Children enrolled in private school by a parent, but who are still receiving special education services through the LEA, may have a service plan rather than an IEP. These children should be included in the child count.

2 OSEP recognizes that, rather than referencing a numerical date (such as November 1) for taking its Child Count each year, some States may have identified a specific day of the week in a given month each year (such as the last Friday of each October). In addition, some States may be unable to reference the same Child Count date if, in a given year, that date falls on a weekend. Therefore, it is acceptable for the actual date of the Child Count in any given year to slide within six (6) days of the State-established reference date without generating any error flags upon submission to the Federal data system.