Annual State Application under Part C of IDEA

Annual State Application Under Part C of the Individuals with Disabilities Education Act
As Amended in 2004

Instruction Sheet

Section I

A. Submission Statement for Part C in IDEA

When completing this section:

• Select and check the appropriate submission statement(s) the State is using for this Federal Fiscal Year (FFY). The third statement is optional and should only be checked if the State chooses to submit policies and procedures to OSEP for review under one or more of the conditions specified in the statement. Possible combinations of ‘checked’ statements are as follows: 1; 2; 1 and 3; or 2 and 3.

B. Conditional Approval for FFY 2011 Year

Section I.B is to be completed only if the State received conditional approval for the FFY 2011 grant year.

When completing this section:

• Check only one of the statements provided (1-3).

• The State must follow the directions found in the parenthetical phrases if the second or third statement is checked.

Section II

A. State Policies, Procedures and Descriptions

When completing this section:

• Read each statement (Policies and Procedures; Descriptions)¹.

• Enter, in the cells found to the left of the statements, either a check in one of the cells labeled N (for new policies, procedures or descriptions), R (for revised policies, procedures or descriptions), or OF (for “on file” with OSEP) found in the ‘yes’ column or a date in the cell found in the ‘no’ column. If the cell labeled N or R is checked, the State must submit those policies, procedures or descriptions with the FFY 2012 application. The date in the ‘no’ column is the date by which the State will submit to OSEP required documentation and which date can be no later than June 30, 2013. At least one cell must be completed beside each statement.

• Enter ‘NA’ in the cells to the left of the Optional Policies, Procedures or Descriptions if the provision is not applicable to your State.

B. Assurances and Optional Assurance

When completing this section:

• Read each assurance.

• Enter, in the cells found to the left of the assurance, either a check in the cell found in the ‘yes’ column or a date in the cell found in the ‘no’ column. The date in the ‘no’ column is the date by which the State will complete changes in order to provide the assurance and which date can be no later than June 30, 2013. At least one cell must be completed beside each assurance.

• Enter ‘NA’ in the cells to the left of the Optional Assurance if this assurance is not applicable.

C. Certifications

When completing this section:

• Read each certification statement and place a check in the cells labeled ‘yes’.

D. Statement

To complete the assurance and certification statement:

• Enter the name of the State and official name of the State Agency in the appropriate blanks.

• Print the name and title of the authorized representative of the State.

• Sign the signature block.

• Enter the date the assurance and certification statement was signed.

Section III

Each State’s Application must include a description of how a State proposes to use its funds under Part C. The description must be presented separately for the lead agency and the State Interagency Coordinating Council. States with a fully approved FFY 2011 Application must still submit any appropriate revisions to the ‘Description of Use of Part C Funds.’ (Only States that have submitted percentage allocations in the prior Part C grant application’s ‘Description of Use of Funds of Part C Funds’ section of the application, that are still accurate for the FFY 2012 grant year, do not have to submit a revised ‘Description of Use of Part C Funds’.) States should follow the instructions and use the forms in Section III.

A. Description of Use of Part C Funds for the Lead Agency

When completing 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 under Section A.

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.

B. Maintenance and Implementation Activities for the Lead Agency

When completing this section include:

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

• The approximate amount of funds to be spent for each activity; and

• A subtotal of the amount under Section B.

C. Description of Use of Part C Funds for the Interagency Coordinating Council (ICC)

When completing this section include:

• Totals for the number of ICC 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 under Section C.

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.

D. Maintenance and Implementation Activities for the State Interagency Coordinating Council (SICC)

When completing this section include:

• A description of the nature and scope of each major activity to be carried out under Part C in maintaining and implementing the statewide system of early intervention services. Activities could include coordinating child find identification efforts, ensuring the timely provision and payment 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 amount of funds to be spent for each activity; and

• A subtotal of the amount under Section D.

E. Direct Services

When completing 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 this part, including a description of any services provided to at-risk infants and toddlers and their families for States that provide services to at-risk children as part of its eligibility criteria. The description must include information about each type of service to be provided, including:

  • A summary of the methods to be used to provide the service (e.g., contracts or other arrangements with specified public or private organizations); and

  • The approximate amount (by each direct service) of funds under this part to be used for the direct provision of early intervention services.

Provide subtotals of the amount under Section E and for salaries and fringe benefits for direct service employees (discipline).

F. Description of Optional Use of Part C Funds

For any State that does not provide direct services for at-risk infants and toddlers under 20 U.S.C. 1437(a)(4), but chooses to use funds under 20 U.S.C. 1438(5), each Application must include a description of how these funds will be used. Specifically, a State may use Part C funds for initiating, expanding, or improving collaborative efforts related to at-risk infants and toddlers, including establishing linkages with appropriate public or private community-based organizations, services, or personnel for the purpose of:

• Identifying and evaluating at-risk infants and toddlers;

• Making referrals of at-risk infants and toddlers who are identified and evaluated; and

• Conducting periodic follow-up on at-risk infants and toddlers to determine if the status of the infant or toddler’s eligibility for Part C services has changed.

Provide a subtotal of the amount under Section F.

G. Activities by Other State or Local Public Agencies

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 agency will receive; and

• A summary of the purposes for which the funds will be used.

Provide subtotal of amount under Section G.

H. Totals

Enter the subtotal amounts for Sub Sections A-G found in Section III and any indirect costs to be charged to the State’s FFY 2012 Part C funds based on the information and documentation provided by the State in Section IV.B. The subtotal amounts (Rows 1-8) should total the estimated grant application amount. (A State may apply for less than the full estimated allotted amount.)

Section IV

A. System of Payments / Use of Insurance / Program Income

When completing this section:

• Place a check in one of the two blanks provided. By entering a check in the appropriate blank the State is indicating whether the State does or does not have a system of payments policy for Part C services under 20 U.S.C. 1432(4)(B), which policy may include the use of public insurance or benefits, private insurance or family fees, such as a sliding scale, to pay for Part C services. Such a policy must be on file with OSEP and reflected in the State’s response under Section II.A of the Application.

If the State has adopted new or has revised its existing policies and procedures regarding its system of payments, it must submit these policies and procedures under Section II of the Application.

B. Restricted Indirect Cost Rate/Cost Allocation Plan Information

Lead agencies that are not State educational agencies (SEAs) (as well as any outlying areas that have the Department of Interior as its cognizant Federal agency, even if an SEA) must complete the requested information on indirect costs in Appendix A, Part III of the Application and submit the required documentation. Because the IDEA (20 U.S.C. 1437(b)(5)(B)) has a statutory requirement that prohibits the use of Federal Part C funds to supplant non-Federal funds, the Education Department General Administration Regulations (EDGAR), at 34 CFR §§76.563-76.569, require that Part C lead agencies use an approved restricted indirect cost rate or cost allocation plan for the Part C program. The cost principles contained in the Office of Management and Budget (OMB) Circular A-87 also apply. (Refer to OSEP Memorandum 99-2 for additional information.) States must also submit with the Application documentation that the Part C lead agency has an approved final restricted indirect cost rate agreement or cost allocation plan for the Part C program that is applicable for FFY 2012 (effective July 1, 2012 through June 30, 2013).

1 The Optional Technical Assistance Checklist – Application Requirements found in PL 108-446, previously found in Section V of this application packet, is now found at http://www.ed.gov/fund/grant/apply/osep/2011apps.html. This checklist is provided to assist States in the completion of OMB Information Collection 1820-0550.

Instruction Sheet for Part C Annual State Application: FFY 2012 Instruction Sheet - 3

OMB No. 1820-0550/Expiration Date: