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Forms

PW 123: Certification of Need for Infants, Toddlers, and Families Waiver (PDF)
PW 123: Certification of Need for Infants, Toddlers, and Families Waiver - Spanish Version (PDF)
PW 123A: Recertification of Need for Infants, Toddlers, and Familes Waiver (PDF)
PW 457: Certification of Choice for Infants, Toddlers, and Families Medicaid Waiver (PDF)
PW 457A: Fair Hearing Request for Infants, Toddlers, and Families Waiver (PDF)
PA 1768: Home and Community Based Services (HCBS) Eligibility/Ineligibility/Change Form (PDF)
Permission to Evaluate (PDF)
Permission to Re-evaluate (PDF)
Waive Re-evaluation (PDF)
The Early Intervention Process: Evaluation Report (PDF)
The Early Intervention Process: Evaluation Report With Annotations (PDF)
Invitation to Participate in IEP Meeting (PDF)
Parent Consent to Excuse Members for IEP Meeting (PDF)
Individualized Family Service Plan (IFSP) (PDF)
Individualized Education Program with Annotations (IEP) (PDF)
Notice of Recommended Eduational Placement Prior Written Notice (NOREP) (PDF)
Parent's Rights Agreement (PDF)
Parent's Rights Agreement (Spanish) (PDF)
Procedural Safeguard Cover Letter (PDF)
Procedural Safeguards Notice (PDF)
Voluntary Authorization to Release Information (PDF)
Complaint Resolution Process (PDF)
EI Complaint Registry Form (PDF)
Schedule of Revenue and Expenditures (PDF)
FY 08-09 Fee Schedule with COLA (PDF)
Preschool EI SEPRN Announcement Form (PDF)

For additional information, please contact:

Carl Beck |
Pennsylvania Department of Education - OCDEL
333 Market Street | Harrisburg, PA 17126-0333
Phone: 717.214.7130
cabeck@pa.gov | www.education.state.pa.us