UTS ProKids

First Steps Information

http://www.firststeps.in.gov

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

IDEA, Part C State Application for Indiana

IN 2005-2010 SPP

APR 2005

APR 2006

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 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