Arizona Early Intervention Program

IDEA 2011 RequirementsProcedural Safeguards-Prior Written Notice and

Consent-

Consent - What’s New? Activity

Screening New

Child Assessment New

Use of Insurance (Public/Private) New

Activities that Require Consent and Prior Written

Notice Activity Requires

ConsentRequires

Prior Written Notice

Screening X X

Evaluation X X

Eligibility Determination X

Child Assessment X

Initiate/Change Provision of Services

X X

Use of Insurance (Private or Public)

X

Disclosure of Records & Personally Identifiable Information

X

Prior Written Notice

Prior Written Notice is required under IDEA, Part C to ensure

families are provided information about the actions being proposed

or refused surrounding their child’s participation in AzEIP

before the action takes place.

Prior Written Notice

Is intended to give families information so they can make

informed choices and decisions in the delivery of supports and

services for their child and family.

Prior Written Notice

Must be given to the parents a reasonable time before the Early Intervention Program proposes or refuses to initiate or change:

•Identification (screening);

•Evaluation;

•Placement (eligibility); and

•The provision of appropriate early intervention services.

Prior Written Notice

The notice must be in sufficient detail to inform the parent about: •The action that is being proposed or refused; •The reasons for taking the action; and •All procedural safeguards available under the federal regulations, including a description of mediation, how to file a complaint and a due process hearing, and the timelines under those procedures.

Prior Written Notice

The notice must be:•understandable to the general public, and•provided in the native language of the parent, unless it is clearly not feasible to do so.

–if the native language or other mode of communication of the parent is not a written language, the notice must be translated orally or by other means to the parent in the parent’s native language or other mode of communication, unless clearly not feasible to do so.

 Prior Written Notice Table 

Activity AzEIP Form to be used

Identification – Determining if Child Suspected of a Developmental Delay   

Propose to Conduct Screening Consent for Screening – Prior Written Notice

(GCI-1082A) Evaluation

 

Propose to evaluate to determine initial AzEIP eligibility Consent for Evaluation – Prior Written Notice

(GCI-1038A)Refuse to evaluate Prior Written Notice

(GCI-1050A)Propose to evaluate to re-determine AzEIP eligibility Prior Written Notice

(GCI-1050A) Placement – Eligibility Determination

 

Propose eligibility after completion of record review Prior Written Notice(GCI-1050A)

Propose eligibility after completion of evaluation Prior Written Notice(GCI-1050A)

Refuse eligibility after completion of evaluation 

Prior Written Notice(GCI-1050A)

Propose to change eligibility status after re-evaluation Prior Written Notice(GCI-1050A)

 Provision of Early Intervention Services

 

Propose the type, intensity, frequency, methods and/or duration of early intervention services   

IFSP Informed Consent by Parent(s) for Services Page(GCI-1021O)

Propose to change the type, intensity, frequency, methods and/or duration of early intervention services

Refuse to provide the type, intensity, frequency, methods and/or duration of an early intervention service

Prior Written Notice(GCI-1050A)

 Prior Written Notice

(GCI-1050A) 

Refuse to change the type, intensity, frequency, methods and/or duration of an early intervention service

Thank You!For more information: www.azdes.gov/azeip