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THIS IS NOT A FUNCTIONING COPY OF THE NATIONAL SURVEY.  IT IS FOR DISPLAY PURPOSES ONLY. Section 1: RESPONDENT/CONTACT INFORMATION Share  1. Are you a Part C Coordinator? Yes No Share  2. What is the scope of the Part C Coordinator job responsibilities? Part C 0-3 Only Part C and Part B-619 Part C, B-619 and Early Elementary Part C and Other Obligations Other   Share  3. What position in the Part C system do you hold? Share  4. Section 1 was reviewed and/or updated on: January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2000 2001 2002 2003 2004 2005 2006 2007 2008 Share  5. Section 1: Comments Section 2: LEAD AGENCY INFORMATION Share  6. Who is the lead agency? Share  7. What is the lead agency type? Co-Lead Education Health MH/MR/DD Other   Share  8. Has the lead agency changed since full implementation of Part C? Yes No Share  9. What entity became the new lead agency? Another state department Another bureau or agency within same department Share  10. How many times has lead agency changed? Share  11. What was the date of the last lead agency change? January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Share  12. Is a change in lead agency currently being considered? Yes No Share  13. What is the legal base of authority (authorization for the system) for the Part C system and Lead Agency? Executive Order   State Statute   State Regulations   Other Share  14. Indicate the following items that pertain to your Part C system? Regulations   Standards   Policies   Procedures   Guidance Documents   Other Share  15. How are routine updates and revisions to regulations/standards/policies disseminated? Informational Materials   Memorandums   Local/Regional Trainings   Practice or Operations Manual   Web Site   Other Share  16. What topics have relevant service guidelines or TA documentation? Autism Spectrum Disorder   Speech/Language   Down syndrome   Developmental Delay   Other Share  17. Check the items that apply to the IFSP form. A statewide IFSP form is available   A statewide IFSP form is mandated   Local providers may develop their own IFSP form   An electronic IFSP is available   User manual   Parent Manual   Targeted Training   Other Share  18. Describe the State supervision and monitoring system. Focused monitoring (Strong use of data prior to on-site and focus on 3-5 key standards   Overall compliance monitoring (Detailed look at a number of standards on-site)   Combination of focused and compliance monitoring   Outcome based monitoring (Is developmental progress being made / Are developmental needs being met)   Other Share  19. How often does the State monitor local lead/provider agencies? Every year Every 2 years Every 3 years As needed based on data review Providers are on different cycles based on previous monitoring visit Other   Share  20. Section 2 was reviewed and/or updated on: January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2000 2001 2002 2003 2004 2005 2006 2007 2008 Share  21. Section 2: Comments Section 3: PART C STAFFING All counts in this section are in terms of Full Time Equivalents; (FTE's) Share  22. STATE OFFICE (%FTE for all answers)   Total State Employee Contracted Staff State Funded Federal Funded State AND Federal Funded Other Funded Part C Coordinator Professional Positions Data Manager Administrative Support Other1: Please specify Other2: Please specify Other3: Please specify Share  23. If you quantified Other 1, Other 2 or Other 3 for any of the counts in the State Office counts, please name the position type(s).   Position Type Other1: Other2: Other3: Share  24. REGIONAL LEVEL (%FTE for all answers)   Total State Employee Contracted Staff State Funded Federal Funded State AND Federal Funded Other Funded Part C Coordinator Professional Positions Data Manager Administrative Support Other1: Please specify Other2: Please specify Other3: Please specify Share  25. If you quantified Other 1, Other 2 or Other 3 for any of the counts in the REGIONAL counts, please name the position type(s).   Position Type Other1: Other2: Other3: Share  26. Section 3 was reviewed and/or updated on: January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2000 2001 2002 2003 2004 2005 2006 2007 2008 Share  27. Section 3: Comments Section 4: EDUCATION, CERTIFICATION AND CREDENTIALS Share  28. Are there certifications or credentials specific to early intervention/Part C? Yes No Share  29. Describe the credential or certification system for early intervention personnel providing special instruction. System of required training   System of required training with proficiency test   System of required training with proficiency test and   Portfolio model   Training and/or mentorship towards competencies   Other Share  30. Is there any orientation or specific training that is required of any EI personnel before beginning to provide services? Yes No Share  31. Is there specific training that is required of EI personnel providing special instruction while they are a service provider? Yes No Share  32. Is there specific required training for OT's, PT's, and SLP's? Yes No Share  33. Is there a higher education consortium? Yes No Share  34. Is any specific training for EI professionals required before they begin providing services? Yes No Share  35. Are personnel required to get continuing education units (C.E.U.'s) specific to early intervention? Yes No Share  36. List any professional categories that have been added or created for personnel that are not part of the federal requirements. Share  37. Section 4 was reviewed and/or updated on: January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2000 2001 2002 2003 2004 2005 2006 2007 2008 Share  38. Section 4: Comments Section 5: STATE INTERAGENCY COORDINATING COUNCIL (SICC) Share  39. What is the age range for SICC jurisdiction/advisory capacity? 0-3 0-5 0-8 Other   Share  40. What is the SICC meeting frequency? Monthly Bi-Monthly Quarterly Other   Share  41. Assess the effectiveness of the SICC. 1 - Very Unsuccessful 2 3 4 5 - Very Successful Share  42. Does the SICC have staff? Yes No Share  43. What is the FTE number of staff supporting the SICC? Share  44. Does the lead agency fund SICC activities? Yes No Share  45. What kinds of funding support SICC activities? State (Lead Agency Funds)   Federal   Other State Agency Funds   Other Share  46. What kinds of activities does the SICC funding support? SICC Staff Support   Travel and related costs including meals   Meeting room and refreshment costs   Consultant Services   Member stipend   Printing and Postage   Parent/Family Member Participation   Other Share  47. What methods are used to support SICC family participation? Child care reimbursement   Ability to direct bill all costs and expenses   Travel and related costs including meals   Technology to assist in obtaining e-mail, faxes   Stipend or consulting fee   Telephone charge card   The purchase of e-mail or other Internet services   Other Share  48. Are financial supports provided to families in advance of the meetings? Yes No Share  49. Section 5 was reviewed and/or updated on: January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2000 2001 2002 2003 2004 2005 2006 2007 2008 Share  50. Section 5: Comments Section 6: SICC SUB-COMMITTEE STRUCTURE Share  51. What types of sub-committees does the SICC operate? Finance   Long Range Planning   Personnel Preparation/CSPD   Child Find   Public Relations