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.

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. 

100% funded with Part C Funds $0.00

Subtotal of amount under A:$0.00

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.

Major Activity Part C Funds to be Spent Description of Activities

Comprehensive Structure $0 Funding of 25 CFCs to continue a consistent, comprehensive statewide system including a provider network, intake, eligibility determination, service coordination and development of IFSPs as well as the following: Local Interagency Councils to coordinate child find activity & provider communications, Parent Liaison support to families, Developmental Pediatric Consultation for professional assistance on child development concerns, and social-emotional consultation activities.

Subtotal of amount under B: $0.00

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.

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.

Subtotal of amount under C:$0 

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

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.

Major Activity Part C Funds to be Spent Description of Activities

Subtotal of amount under D: $0.00

E. Direct Services (Funded by Part C Federal Dollars)

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 of funds under this part to be used for the direct provision of early intervention services.

Provide subtotals of the amount and for salaries and fringe benefits for direct service employees (discipline). (Add columns and rows as needed.)

Direct Service Part C Funds to be Spent Summary of Methods to be Used to Provide Service
Assistive Technology Devices and Services $243,200 Provider Agreements with public and private organizations and individuals
Audiology $98,500 Provider Agreements with public and private organizations and individuals
Developmental Therapy $1,813,630 Provider Agreements with public and private organizations and individuals
Family Training/ Support $2,676,461 Provider Agreements with public and private organizations and individuals
Medical Diagnostic Services (evaluation purposes only) $19,700 Provider Agreements with public and private organizations and individuals
Nursing $3,700 Provider Agreements with public and private organizations and individuals
Nutrition Services $168,700 Provider Agreements with public and private organizations and individuals
Occupational Therapy $978,500 Provider Agreements with public and private organizations and individuals
Physical Therapy $1,056,952 Provider Agreements with public and private organizations and individuals
Psychological & Other Counseling $432,400 Provider Agreements with public and private organizations and individuals
Service Coordination $7,271,3079 Provider Agreements with public & private organizations (Child & Family Connections agencies), Service Coordination paid via a modified fee-for-service system, Current period payments based on the # of children served in a recent past period, Funds added for good performance & may be subtracted for failure to meet performance standards
Speech Language Therapy $2,517,961 Provider Agreements with public and private organizations and individuals
Transportation services $6,100 Provider Agreements with public and private organizations and individuals
Vision services $29,300 Provider Agreements with public and private organizations and individuals
Subtotal $17,318,213 amount under E

F. Description of Optional Use of Part C Funds (For States that Do Not Provide Direct Service for At-Risk Infants and Toddlers)

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.

Subtotal of amount under F: $0

G. Activities by Other 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.

Subtotal of amount under G: $0 

H. Totals

Enter the subtotal amounts for Sub Sections A-G found in Section III and any indirect costs charged as specified in Section IV.B. The sub total amounts (Rows 1-8) should total the estimated grant application amount. (A State may apply for less than the full estimated allotted amount.)

Enter the subtotal amounts for Sub Sections A-G found in Section III of this application.

Row No. Section Amount
1. III.A. $0
2. III.B. $0
3. III.C. $0
4. III.D. $0
5a III.E. (Direct Service) $17,318,213
5b III.E. (Direct Service Employees)  $0
6. III.F. $0
7. III.G. $0
Enter any Indirect Costs to be Charged to FFY 2011 Funds (See Section IV.B of this application.)
8. IV.B  $0
9. Total $17,318,213