First Steps Information

http://www.firststeps.in.gov

 

Independent Evaluation and External Review of First Steps

 

I.  State Performance Plan (SPP) – Annual Progress Reports (APR)

IDEA, Part C State Application for Indiana

IN 2005-2010 SPP

APR 2005

APR 2006

FFY 2006 OSEP Determinations

 

II.  Public Reporting of FFY 2006-2007 Annual Progress Reporting

Each state is required to public post its SPP and APR. The Indicator Tables provide a snapshot of the progress for the state and the individual clusters. Each indicator is fully explained in the State Performance Plan and in the APR FFY 2006 - 2007.

Indicator 1 – Timely services

Indicator 2 – Natural Environments

Indicator 4 – Family Outcomes FFY 2006

Indicator 5 & 6 – Child Counts

Indicator 7 – 45 day timeline

Indicator 8 - Transition

 

Forms

Authorizations/Approvals

Prior Approval Request Form (SF 51311- Fill -in)

Final AT Policy and Form SF (50881 - Fill-in)

Request for Authorization for Audiology Services (SF51930 - Fill-in)

Eligibility Determination

Physician's Health Summary (SF51929 - Fill-in)

Eligibility Form (SF50054)

Documentation of Team Discussion (SF51928 (R/10-06) BCD 0118 Fill-in

Family Information Update
Family Information Update (SF 51358 - Fill-in)

Family Interviews

Family Interview (SF 51313 - Fill-in)

Family Interview, Spanish version

Exit Summary (SF 51310 - Fill-in)

Exit Summary, Spanish version
Intake
 CSHCS Enrollment Checklist (SF48134)

Income and Insurance

Hoosier Healthwise Enrollment Checklist

Private Medical Insurance Consent (SF51308 - Fill-in)

Private Medical Insurance Supplement (SF51309 - Fill-in)

Cost Participation Expenses Worksheet (SF 51359 )

Cost Participation Co-Payment Form (SF 51361)

Family Information Update (SF 51358 - Fill-in)
IFSP (Initial or Annual)

IFSP Form (SF 46514 - Fill-in)

IFSP, Spanish version

Annual IFSP Checklist (SF 51919 - Fill-in)

Changes to the IFSP (SF 51841 - Fill-in)

Documentation of Team Discussion (SF 51928 - Fill-in)

Reason for Delay of IFSP (revised SF 5131 - Fill-in)

Outcome Review (SF 51838 Fill-in)

Request for Authorization/Meeting Minutes (SF51839)

Six (6) Month IFSP Review Packet

6 Month (or other planned) IFSP Review Cover Sheet (SF 51840)

Outcome Review (SF 51838 - Fill-in)

Request for Authorization/Meeting Minutes (SF 51839)

 

Changes to the IFSP Packet

Service Change to the IFSP Checklist (SF 51921 - Fill-in)

Documentation of Team Discussion (SF 51928 - Fill-in)

Changes to the IFSP (SF 51841 Fill-in)

On-going Service

Face to Face Summary Sheet (sample)

Progress Report (sample)
Referral
 Referral Form (sample)
Releases

Documentation of Receipt of Rights/Consent to Proceed/Permission to Access (SF 51842)

Authorization to Release and Share Medical Information page 1 (SF 49006)

Authorization to Release and Share Medical Information page 2 (SF 49006)

General Reciprocal Consent to Release and Share Information (SF51675 - Fill-in)

Electronic Database Release (CRO 1) page 1 (SF 49006)

Electronic Database Release (CRO 1) page 2 (SF 49006)

Provider Reciprocal Consent to Release and Share Information (SF 49760 R-3/6-07 - Fill-in)
Termination

Ongoing Record Termination (SF 52001 - Fill-in)

 

Transfer to another County

 Documentation of Transfer to Another County (SF 52000 fill-in)
Transition Forms

Family Information Update (SF51358 (R3/3-07)/BCD 0094 - Fill-in)

Request for Authorization for Transition Meeting / Transition Checklist (SF51670(R3/3-07) BCD 0103 Fill-in)

Transition Meeting Notification (SF51671(R3/3-07) BCD 0104 - Fill-in)

First Steps 30 Month Notice to Local Educational Agency (LEA) SF51673(R3/3-07) BCD 0106 - Fill-in

Individualized Family Transition Plan (SF 51672 R3/3-07)

First Steps Transition Meeting Minutes (SF 51674 R3/3-07)

Transition Plan Instructions