Form 869-5 Table1 - Part B - REPORT OF CHILDREN WITH DISABILITIES R

Page 5 of 5

TABLE 1

REPORT OF CHILDREN WITH DISABILITIES

RECEIVING SPECIAL EDUCATION

UNDER PART B OF THE INDIVIDUALS WITH

DISABILITIES EDUCATION ACT, AS AMENDED

Specific State-Designated Date Between October 1 and December 1 of 2007

Paperwork Burden Statement

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 1820-0043. The time required to complete this information collection is estimated to average 2 hours per LEA and 8.5 hours per SEA response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, D.C. 20202. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: Office of Special Education Programs, U.S. Department of Education, 400 Maryland Avenue, SW, Washington, D.C. 20202.

Authorization: P.L. 108-446, Section 618(a)(1)(A)(i) and Section 618(a)(3); 34 CFR §§300.640, 300.641, 300.642(b), 300.643, 300.644, 300.645

Due Date: February 1, 2008

Sampling Allowed: Section A – Not applicable

Section B - No for age group, yes for discrete ages

Section C – No

Section D - No for age group, yes for discrete ages

Section E – No

Section F – Not applicable

Send Form to: Patricia J. Guard, Acting Director

Office of Special Education Programs

Part B Data Reports

Program Support Services Group

Mail stop 2600

550 12th Street, S.W.

Washington, D.C. 20202

Attn: Cheryl Broady

General Instructions

1. Report the number of children with disabilities receiving special education and related services according to an individualized education program or service plan¹ in place on the count date. This must be an unduplicated count; each child is counted once and only once.

2. All totals must represent the sum of the preceding rows or columns. Report zeros (0) where there are no children to report in a data cell.

3. The count is to be taken on a state-designated date between October 1, 2007 and December 1, 2007 (inclusive). States must use the same count date each year. Children ages 3-5 and 6-21 must be reported according to their disability category and discrete age year based upon each child's age as of the data collection date. Children ages 3-5 and ages 6-21 should be reported by their race/ethnicity and disability category.

4. If a child has more than one disability, the child must be reported accorded to the following procedure:

• If a child has only two disabilities and those disabilities are deafness and blindness, and the child is not reported as having a developmental delay, that child must be reported under the category “deaf-blindness.”

• A child who has more than one disability and is not reported as having deaf-blindness or as having a developmental delay must be reported under the category “multiple disabilities.”

5. The reporting of data on developmental delay is optional. Only children ages 3 through 9 may be reported in the developmental delay disability category and then only in States with the diagnostic instruments and procedures to measure delays in physical, cognitive, communication, social or emotional, or adaptive development. States must have defined and established eligibility criteria for developmental delay in order to report children in this category. Although Federal law does not require that States and LEAs categorize children according to developmental delay, if this category is required by State law, States are expected to report these children in the developmental delay category.

6. The reporting of data on youth 22 and older is optional.

7. While States may use sampling to obtain data for discrete ages, data for age groupings must be actual counts.

7. STATES SHOULD NOT PROVIDE PERCENTAGES IN SECTIONS B THROUGH E, AS THEY WILL BE CALCULATED AFTER THE COUNTS ARE SUBMITTED.

7. In providing data for this collection, the State is to submit complete and unsuppressed data.

Sampling Guidelines

States may use sampling to obtain data for discrete ages categories; however, data for age groupings must be actual counts. States may also sample to provide counts of students 22 years old and above. When sampling is used, a description of the sampling methodology outlining how the design will yield valid and reliable estimates must be submitted to OSEP for approval. The level of precision of the estimates to be obtained must be specified in this description. States must submit sampling plans to OSEP for approval by September 1 of the reporting year (that is, the September prior to the child count).

OSEP will evaluate the validity of the sampling plans using the guidelines below.

1. The sampling framework may include all school districts or a sample of districts. If a State chooses to sample districts, all districts with average daily memberships (ADM) of over 50,000 must be included in the sample. States with fewer than 25 districts with ADMs over 25,000 must include all districts with over 25,000 ADMs. The total number of districts sampled must equal or exceed 100. If the total number of districts in the State is 100 or fewer, data must be collected from all districts.

2. When sampling students, whether for all districts or for a sample of districts, data must be collected separately for each Federal disability category. All students whose domicile is in a district must be eligible for the sample including those students served in cooperatives and/or intermediate units or in residential programs out of the district.

3. A minimum sample of 100 children must be used by all districts, except where the total number in a disability category is less than 100. In such a case, data must be collected for all students in that category.

States that use sampling will provide OSEP with weighted rather than unweighted data. A description of the final sample sizes and the weights used should also be provided at the time the data are provided.

Specific Instructions

Section B. Discrete Age by Disability of Children Ages 3-5 Receiving Special Education

In Section B, indicate for each discrete age and type of disability the number of children receiving special education and related services according to an individualized education program. States are required to complete the entire table, providing data for discrete ages, age groupings, and disability categories. States may use sampling for data on discrete ages, if the State does not collect data for individual ages. See the section on Sampling Guidelines for more information.

Section C. Race/Ethnicity by Disability of Children Ages 3-5 Receiving Special Education

In Section C, report the total number of students with disabilities ages 3-5 by disability condition and race/ethnicity category. States may not use sampling for race/ethnicity categories.

In October 1997, OMB issued standards for the collection and aggregration of data on race and ethinicity (see “Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity”).  In that announcement, OMB identified a minimum of five racial categories -- American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, and White -- and one ethnic category -- Hispanic or Latino.  Additionally, OMB announced that individuals should be allowed to select as many race/ethnicity categories as were applicable.  This data collection allows for the reporting of only one race or ethnicity category per individual and is therefore not in compliance with these standards. OSEPand the Department of Education (ED) are considering changes to the categories used for reporting aggregate data to bring this collection into compliance with OMB’s standards. For the time being, data should be reported using the five racial categories described below. 

Enter an unduplicated number of all children with disabilities ages 3-5 by race/ethnicity category. The race/ethnicity categories are defined as follows:

American Indian or Alaska Native	A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment.
Asian or Other Pacific Islander	A person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands. This includes, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, Vietnam, Hawaii, Guam, and Samoa.
Black (not Hispanic)	A person having origins in any of the Black racial groups of Africa.
Hispanic	A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
White (not Hispanic)	A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Total	The unduplicated total across the race/ethnicity designations.

Note that children should only be reported in one race/ethnicity category.

States are required to complete the entire table providing data for discrete ages, age groupings, and race/ethnicity categories. States that have discrete age and/or race/ethnicity data available should base the report on actual (not sample) data. States that do not have data for each discrete age or race/ethnicity categories are required to report actual data for the age grouping 3-5 and to use sampling for discrete ages and race/ethnicity categories. See the section on Sampling Guidelines for more information.

Section D. Discrete Age by Disability of Children Ages 6-21 Receiving Special Education

Indicate for each age category and type of disability the number of children receiving special education and related services according to an individualized educational program. States may report the number of children experiencing developmental delay(s) ages 6 through 9 who are receiving special education and related services.

As in Section B above, States are required to complete the entire table providing data for discrete ages, age groupings, and disability categories. States that have discrete ages should base the report on actual (not sample) data. States that do not have data for each discrete age are required to report actual data for the age groupings 6-21, and to use sampling for discrete ages. If a State has actual data for discrete ages 6 through 21 and not for 22 and above, the State may sample for the 22 and above category. See the section on Sampling Guidelines for more information.

Section E. Race/Ethnicity by Disability of Children Ages 6-21 Receiving Special Education

Report the total number of students with disabilities ages 6-21 by disability condition and race/ethnicity categories. States may not use sampling for race/ethnicity categories. Use the race/ethnicity categories defined under Section B. Note that students may only be reported in one race/ethnicity category.

Section F. Certification

This report must be signed by the Chief State School Officer or the individual authorized by the State to certify these counts.

Please note: To reduce data burden, the total number of children in each gender and Limited English Proficiency status category are included on the Educational Environments report (Table 3). These data are not reported on Table 1.

U.S. DEPARTMENT OF EDUCATION OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES OFFICE OF SPECIAL EDUCATION PROGRAMS	TABLE 1 REPORT OF CHILDREN WITH DISABILITIES RECEIVING SPECIAL EDUCATION PART B, INDIVIDUALS WITH DISABILITIES EDUCATION ACT, AS AMENDED	PAGE 1 OF 8 OMB NO.: 1820-0043 FORM EXPIRES: 08/31/2009
	2007

STATE: ____________________

SECTION A. DATA COLLECTION DATE

COUNT DATE:

MONTH

DAY

YEAR

U.S. DEPARTMENT OF EDUCATION OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES OFFICE OF SPECIAL EDUCATION PROGRAMS	TABLE 1 REPORT OF CHILDREN WITH DISABILITIES RECEIVING SPECIAL EDUCATION PART B, INDIVIDUALS WITH DISABILITIES EDUCATION ACT, AS AMENDED	PAGE 2 OF 8 OMB NO.: 1820-0043 FORM EXPIRES: 08/31/2009
	2007

STATE: ____________________

SECTION B. DISCRETE AGE BY DISABILITY FOR CHILDREN AGES 3-5 RECEIVING SPECIAL EDUCATION

DISABILITY	AGE AS OF DATA COLLECTION DATE
	3	4	5	3-5	3-5 (PERCENT)1
MENTAL RETARDATION
HEARING IMPAIRMENTS
SPEECH OR LANGUAGE IMPAIRMENTS
VISUAL IMPAIRMENTS
EMOTIONAL DISTURBANCE
ORTHOPEDIC IMPAIRMENTS
OTHER HEALTH IMPAIRMENTS
SPECIFIC LEARNING DISABILITIES
DEAF-BLINDNESS
MULTIPLE DISABILITIES
AUTISM
TRAUMATIC BRAIN INJURY
DEVELOPMENTAL DELAY2
TOTAL: (Sum of all the above)					100%

¹ STATES SHOULD NOT PROVIDE PERCENTAGES IN THIS SECTION, AS THEY WILL BE CALCULATED AFTER THE COUNTS ARE SUBMITTED.

² States must have defined and established eligibility criteria for developmental delay in order to use this category for reporting.

ED FORM: 869-5

U.S. DEPARTMENT OF EDUCATION OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES OFFICE OF SPECIAL EDUCATION PROGRAMS	TABLE 1 REPORT OF CHILDREN WITH DISABILITIES RECEIVING SPECIAL EDUCATION PART B, INDIVIDUALS WITH DISABILITIES EDUCATION ACT, AS AMENDED	PAGE 3 OF 8 OMB NO.: 1820-0043 FORM EXPIRES: 08/31/2009
	2007

STATE: ____________________

SECTION C. RACE/ETHNICITY BY DISABILITY OF CHILDREN AGES 3-5 RECEIVING SPECIAL EDUCATION

DISABILITY	RACE/ETHNICITY
	AMERICAN INDIAN OR ALASKA NATIVE	ASIAN OR OTHER PACIFIC ISLANDER	BLACK (NOT HISPANIC)	HISPANIC	WHITE (NOT HISPANIC)	TOTAL
MENTAL RETARDATION
HEARING IMPAIRMENTS
SPEECH OR LANGUAGE IMPAIRMENTS
VISUAL IMPAIRMENTS
EMOTIONAL DISTURBANCE
ORTHOPEDIC IMPAIRMENTS
OTHER HEALTH IMPAIRMENTS
SPECIFIC LEARNING DISABILITIES
DEAF-BLINDNESS
MULTIPLE DISABILITIES
AUTISM
TRAUMATIC BRAIN INJURY
DEVELOPMENTAL DELAY1
TOTAL: (Sum of all the above)
TOTAL (PERCENT)2						100%

¹ States must have defined and established eligibility criteria for developmental delay in order to use this category for reporting.

² STATES SHOULD NOT PROVIDE PERCENTAGES IN THIS SECTION, AS THEY WILL BE CALCULATED AFTER THE COUNTS ARE SUBMITTED.

ED FORM: 869-5

U.S. DEPARTMENT OF EDUCATION OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES OFFICE OF SPECIAL EDUCATION PROGRAMS	TABLE 1 REPORT OF CHILDREN WITH DISABILITIES RECEIVING SPECIAL EDUCATION PART B, INDIVIDUALS WITH DISABILITIES EDUCATION ACT, AS AMENDED	PAGE 4 OF 8 OMB NO.: 1820-0043 FORM EXPIRES: 08/31/2009
	2007

STATE: ____________________

SECTION D. DISCRETE AGE BY DISABILITY OF CHILDREN AGES 6-21 RECEIVING SPECIAL EDUCATION

DISABILITY	AGE AS OF DATA COLLECTION DATE
	6	7	8	9	10	11
MENTAL RETARDATION
HEARING IMPAIRMENTS
SPEECH OR LANGUAGE IMPAIRMENTS
VISUAL IMPAIRMENTS
EMOTIONAL DISTURBANCE
ORTHOPEDIC IMPAIRMENTS
OTHER HEALTH IMPAIRMENTS
SPECIFIC LEARNING DISABILITIES
DEAF-BLINDNESS
MULTIPLE DISABILITIES
AUTISM
TRAUMATIC BRAIN INJURY
DEVELOPMENTAL DELAY1
TOTAL: (Sum of all the above)

¹ States must have defined and established eligibility criteria for developmental delay in order to use this category for reporting.

ED FORM: 869-5

U.S. DEPARTMENT OF EDUCATION OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES OFFICE OF SPECIAL EDUCATION PROGRAMS	TABLE 1 REPORT OF CHILDREN WITH DISABILITIES RECEIVING SPECIAL EDUCATION PART B, INDIVIDUALS WITH DISABILITIES EDUCATION ACT, AS AMENDED	PAGE 5 OF 8 OMB NO.: 1820-0043 FORM EXPIRES: 08/31/2009
	2007

STATE: ____________________

SECTION D (CONTINUED)

DISABILITY	AGE AS OF DATA COLLECTION DATE
	12	13	14	15	16	17
MENTAL RETARDATION
HEARING IMPAIRMENTS
SPEECH OR LANGUAGE IMPAIRMENTS
VISUAL IMPAIRMENTS
EMOTIONAL DISTURBANCE
ORTHOPEDIC IMPAIRMENTS
OTHER HEALTH IMPAIRMENTS
SPECIFIC LEARNING DISABILITIES
DEAF-BLINDNESS
MULTIPLE DISABILITIES
AUTISM
TRAUMATIC BRAIN INJURY
DEVELOPMENTAL DELAY
TOTAL: (Sum of all the above)

ED FORM: 869-5

U.S. DEPARTMENT OF EDUCATION OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES OFFICE OF SPECIAL EDUCATION PROGRAMS	TABLE 1 REPORT OF CHILDREN WITH DISABILITIES RECEIVING SPECIAL EDUCATION PART B, INDIVIDUALS WITH DISABILITIES EDUCATION ACT, AS AMENDED	PAGE 6 OF 8 OMB NO.: 1820-0043 FORM EXPIRES: 08/31/2009
	2007

STATE: ____________________

SECTION D (CONTINUED)

DISABILITY	AGE AS OF DATA COLLECTION DATE
	18	19	20	21	6-21 (Actual Data)	22+ (Optional)	6-22+ (Optional)	6-21 (PERCENT)1
MENTAL RETARDATION
HEARING IMPAIRMENTS
SPEECH OR LANGUAGE IMPAIRMENTS
VISUAL IMPAIRMENTS
EMOTIONAL DISTURBANCE
ORTHOPEDIC IMPAIRMENTS
OTHER HEALTH IMPAIRMENTS
SPECIFIC LEARNING DISABILITIES
DEAF-BLINDNESS
MULTIPLE DISABILITIES
AUTISM
TRAUMATIC BRAIN INJURY
DEVELOPMENTAL DELAY2
TOTAL: (Sum of all the above)								100%

¹ STATES SHOULD NOT PROVIDE PERCENTAGES IN THIS SECTION, AS THEY WILL BE CALCULATED AFTER THE COUNTS ARE SUBMITTED.

² States must have defined and established eligibility criteria for developmental delay in order to use this category for reporting.

ED FORM: 869-5

U.S. DEPARTMENT OF EDUCATION OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES OFFICE OF SPECIAL EDUCATION PROGRAMS	TABLE 1 REPORT OF CHILDREN WITH DISABILITIES RECEIVING SPECIAL EDUCATION PART B, INDIVIDUALS WITH DISABILITIES EDUCATION ACT, AS AMENDED	PAGE 7 OF 8 OMB NO.: 1820-0043 FORM EXPIRES: 08/31/2009
	2007

STATE: ____________________

SECTION E. RACE/ETHNICITY BY DISABILITY OF CHILDREN AGES 6-21 RECEIVING SPECIAL EDUCATION

DISABILITY	RACE/ETHNICITY
	AMERICAN INDIAN OR ALASKA NATIVE	ASIAN OR OTHER PACIFIC ISLANDER	BLACK (Not Hispanic)	HISPANIC	WHITE (NOT HISPANIC)	TOTAL
MENTAL RETARDATION
HEARING IMPAIRMENTS
SPEECH OR LANGUAGE IMPAIRMENTS
VISUAL IMPAIRMENTS
EMOTIONAL DISTURBANCE
ORTHOPEDIC IMPAIRMENTS
OTHER HEALTH IMPAIRMENTS
SPECIFIC LEARNING DISABILITIES
DEAF-BLINDNESS
MULTIPLE DISABILITIES
AUTISM
TRAUMATIC BRAIN INJURY
DEVELOPMENTAL DELAY1
TOTAL: (Sum of all the above)
TOTAL: (PERCENT)2						100%

¹ States must have defined and established eligibility criteria for developmental delay in order to use this category for reporting.

² STATES SHOULD NOT PROVIDE PERCENTAGES IN THIS SECTION, AS THEY WILL BE CALCULATED AFTER THE COUNTS ARE SUBMITTED.

ED FORM: 869-5

U.S. DEPARTMENT OF EDUCATION OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES OFFICE OF SPECIAL EDUCATION PROGRAMS	TABLE 1 REPORT OF CHILDREN WITH DISABILITIES RECEIVING SPECIAL EDUCATION PART B, INDIVIDUALS WITH DISABILITIES EDUCATION ACT, AS AMENDED	PAGE 8 OF 8 OMB NO.: 1820-0043 FORM EXPIRES: 08/31/2009
	2007

REPORT DUE NO LATER THAN FEBRUARY 1

STATE: ____________________

SECTION F. CERTIFICATION

I CERTIFY that these data represent an accurate and unduplicated count of children with disabilities receiving special education and related services according to an Individualized Education Program on my State’s designated child count date, which falls between October 1 and December 1 of 2007.
AUTHORIZING OFFICIAL
NAME AND TITLE (TYPE OR PRINT)	SIGNATURE	DATE OF SIGNATURE

ED FORM: 869-5

1 Children enrolled in private school by a parent, but who are still receiving special education services through the LEA, may have a service plan rather than an IEP. These children should be included in the child count.