PD-1A/4A Form

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PD 1A/4A FORM CONTENTS:
transmittal letter

#Instructions and Definitions

Table 1

Table 2

Table 3

Table 4

THE STATE EDUCATION DEPARTMENT / THE UNIVERSITY OF THE STATE OF NEW YORK / ALBANY, NY 12234
_____________________________________________________________________________________________________
MANAGER, STRATEGIC EVALUATION DATA COLLECTION, ANALYSIS AND REPORTING
1613 ONE COMMERCE PLAZA
ALBANY, NEW YORK 12234
Tel. (518) 474-7965
Fax (518) 408-3363
E-mail: dataquest@nysed.gov

To:
Special Education Data Managers of BOCES
District Superintendents
Date: September 2004

From: Inni Barone

Subject: PD-1A/4A- BOCES Count of Preschool Students with Disabilities and Buildings/Facilities in which School-age Students with Disabilities Receive Special Education Programs or Services on December 1, 2004. Due between December 1, 2004 and December 17, 2004.

Attached is the PD-1A/4A form to be used to report the number of preschool students with disabilities who are provided preschool special education programs and services, pursuant to Section 4410 of the Education Law, in BOCES-operated approved preschool special education programs and the buildings and facilities in which school-age students with disabilities are provided school-age special education programs and services, as of December 1, 2004.

The 2004-2005, PD-1A/4A form as compared to the 2003-2004, PD-1A/4A form is modified as follows:

Table 1 has been modified to collect information on preschool children with disabilities ages 2-4. In previous years, this information was collected for children, ages 2-5. All children who are 5 years of age on December 1, 2004 and receive special education services are "school-age" students with disabilities and as such, must be reported in Table 2 or Table 3 of this report, not in Table 1.

The New York State Education Department (SED) will confirm the accuracy of information included in this report as part of the program review process, or as is otherwise indicated. To facilitate such a review for your BOCES, please maintain a listing (hard copy or other readily retrievable format) of all students included in this report until June 30, 2011. Upon completing local verification procedures, if it is determined that data are incorrect, a revised report (i.e., PD-1A/4A form) must be submitted to SED.

Please note that the data collected through the PD forms are used in the following reports and activities:

Annual Performance Report for Special Education
Pocketbook of Goals and Results for Individuals with Disabilities
Chapter 655 Report to the Governor and the Legislature on the Status of the State's Schools
Special Education Quality Assurance Reviews
School Report Cards
BOCES Report Cards
Charter School Report Cards
Calculations to identify instances of possible race/ethnicity disproportionately
Other reports required by State or federal statutes
Summary reports for public information to be placed on the Department's website
Evaluation of programs and policies

If you have any questions or are in need of assistance in completing this report, please contact the Strategic Evaluation Data Collection, Analysis and Reporting (SEDCAR) Unit by using the contact information provided in the letterhead. Thank you.

Attachment
cc: Rebecca H. Cort

The University of the State of New York
THE STATE EDUCATION DEPARTMENT
Office of Vocational and Educational Services for Individuals with Disabilities (VESID)
Strategic Evaluation Data Collection, Analysis and Reporting
One Commerce Plaza - Room 1613 — Albany, NY 12234-0001

PD-1A/4A — BOCES Report:

Count of Preschool Students with Disabilities and Buildings/Facilities in Which School-age Students with Disabilities Receive Special Education Programs or Services.

Instructions:

Return one copy of this report by December 17, 2004 to the above address. (This report may not be signed or submitted prior to December 1, 2004.)

Retain one copy (and supporting documentation) in your BOCES for reference and audit purposes. The required retention period ends June 30, 2011.

If you have questions about this report, please call (518) 474-7965 or e-mail your questions to dataquest@nysed.gov

BOCES Information

(Enter 12-digit SED Code Below)

BOCES NAME

ADDRESS (include building name, room number, or mail stop information)

City

State

Zip

Contact Person Information*

NAME

TITLE

TELEPHONE (include Area Code)

FAX

E-MAIL ADDRESS

*All correspondence from the address at the top of this page will be directed to the contact person reported in the PD web-based system at http://pd.nysed.gov. You may update the contact person at any time through the PD web-based system located at http://pd.nysed.gov.

Certification and Assurances

I have reviewed the information reported on this form and certify that this is a complete and accurate count of students with disabilities served on December 1, 2004. I further certify that the students reported were served in accordance with current Individualized Education Programs and received services in accordance with State standards.

__________________________ Original Ink Signature	___________________ Date Signed		*Superintendent Must Sign and Date on or after December 1, 2004*
__________________________________ Name of District Superintendent (Please Type or Print)

Instructions for Completing PD-1A/4A To be Completed by All BOCES

General Directions

Report the unduplicated count of preschool and school-age students with disabilities provided special education programs or services by this BOCES on December 1, 2004. Wherever students are to be reported by age, please report age as of December 1, 2004.
Preschool students with disabilities, provided special education services pursuant to Section 4410 of the Education Law, should be included in Table 1 of this report only.
For purposes of this report, students provided transportation or evaluation services only are not to be included.
Report data in Tables 2 and 3 for all school-age students with disabilities provided special education programs/services regardless of the amount of special education services provided. All school-age students are to be reported in either Table 2 or Table 3, but not in both (count each student as one (1)). Report school-age students receiving special class services only or special class services and other educational services in Table 2 only. Report students receiving other special education services only (e.g., related services, resource room programs, and consultant teacher services) in Table 3 only.
Report school-age students provided services in more than one location in the type of building/facility they attend for the majority of the time they receive BOCES special education programs/services.
Report school-age students provided services in two locations, each for 50 percent of the school day, in the numerically lower line number. For example, a school-age student provided services by BOCES in a public school building that is also attended by non-disabled students (Line 01) for 50 percent of the school day and in a building attended by students with disabilities only (Line 03) for 50 percent of the school day, should be reported in Line 01.
Please use the definitions below to assist you in determining the most appropriate race/ethnicity category for reporting students in Tables 2, 3, and 4. Also, please report the race/ethnicity of students with disabilities consistently with how it is reported by their districts of residence on all Department data collection instruments.

American Indian/Alaskan 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 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, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. The Pacific Islands include Hawaii, Guam, and Samoa.
Black or African American (not Hispanic): A person having origins in any of the Black racial groups of Africa.
Hispanic or Latino: 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.

Directions for Table 1: If this BOCES does not operate an approved preschool special education program, place a check in question #1, and skip question #2. If this BOCES operates an approved preschool special education program, in question 2, provide the number of preschool students with disabilities provided special education programs or services on December 1, 2004. Such services may include special class, SEIT, and/or related services that are provided pursuant to Section 4410 of the Education Law. Do not count preschool students who receive evaluation services only. Also, please note that for students receiving itinerant services and/or related services from more than one approved preschool special education program, only the program that provides itinerant services or is designated by the CPSE to coordinate all related services must count the students in this report.

Directions for Table 2 (School-age Students Provided Special Class Programs by BOCES by Race/Ethnicity): In Columns A-E, provide a count of school-age students with disabilities, by race/ethnicity, provided any configuration of special class services (see NYCRR 200.6(g)(4)(i)(ii) and (iii)). Examples of special class configurations include: 15 students to 1 teacher (15:1), 12 students to 1 teacher plus one supplementary school personnel (12:1+1); 8 students to 1 teacher plus one supplementary school personnel (8:1+1), 6 students to 1 teacher plus one supplementary school personnel (6:1+1) and 12 students to 1 teacher plus a ratio of 1 supplementary school personnel for every three students (12:1+3:1). In Column F, provide the total number of such students. Students provided other special education programs or services in addition to special class programs should also be included in this table. Also, students should be included in this table regardless of the amount of time they receive special class programs.

Directions for Table 3 (School-age Students Provided Educational Services Other Than Special Class Programs by BOCES): In Columns A-E, provide a count of students with disabilities, by race/ethnicity, who are not provided special class services but are provided other special education services by BOCES (e.g., special education related services, resource room programs and, consultant teacher services). Include all school-age students with disabilities to whom the BOCES provides special education services other than special class programs, regardless of where such services are provided and regardless of the amount of such services. Students receiving both special class services as well as other special education services should be reported in Table 2 only. In Column F, provide the total number of such students.

Directions for Table 4: Report the race/ethnicity of school-age students with disabilities who are ages 14-21 as of December 1, 2004. In Line 1, report race/ethnicity of students receiving special class programs and in Line 2, report the race/ethnicity of students receiving special education services other than special class programs.

Additional Information for Line 2 of Tables 2 and 3:

Include in these lines students who receive their related academic instruction in a community setting such as a class operated by BOCES at a place of employment and are involved in supported employment/job coaching experiences in the community for the remainder of the day. In order to be included in Line 2, such students must be provided opportunities to interact with non-disabled individuals other than non-disabled individuals who provide services to them. (Students receiving special class programs as well as supported employment/job coaching should be reported in Table 2 only. Students receiving employment/job coaching only should be reported in Table 3 only.)

BOCES Name: ___________________________ SED Code: ______________________

□	Check here if this BOCES does not operate an approved preschool special education program on December 1, 2004. If this box is checked, skip Table 1 and proceed to Table 2.

Table 1: Count of Preschool Students with Disabilities Provided Special Education Programs and Services
	Ages 3 – 4*	Age 2 **
1. If this BOCES operates an approved preschool special education program pursuant to Section 4410 of the Education Law, report the counts of students provided preschool special education programs or services (i.e., special class, SEIT, and/or related services) on December 1, 2004. Preschool children receiving evaluation services only are not to be counted. Please note that for students receiving itinerant services and/or related services from more than one approved preschool special education program, only the program that provides itinerant services or is designated by the CPSE to coordinate all related services must count the students in this report.

* Children who are 5 years of age on December 1 are "school-age" children and must be reported in Table 2 or Table 3 of this report, not in Table 1.

** Students who are 2 years old on December 1, 2004 (who will turn 3 years old of age by December 31, 2004) and are receiving preschool special education services, pursuant to Section 4410 of the Education Law, should be included in the column for students age 2.

BOCES Name: ___________________________ SED Code: ______________________

Table 2
Buildings and Facilities in Which School-age Students with Disabilities
Receive Special Class Programs Provided by a BOCES
December 1, 2004

		Students Provided Special Class Programs by BOCES by Race/Ethnicity See directions on page 2 for definition and examples of special class programs.					Total Number of Students Provided Special Class Programs by BOCES
Line	Category	A	B	C	D	E	F
Line	Category	American Indian/ Alaskan Native	Asian/Pacific Islander	Black (Not of Hispanic Origin)	Hispanic	White (Not of Hispanic Origin)
1	Number of students with disabilities provided special class programs by BOCES in a public school district building/facility that is also attended by non-disabled students.
2	Number of students with disabilities provided special class programs in other than a public school district building/facility that is also attended by non-disabled students. These buildings could be BOCES owned/leased, rented or used under other agreements.
3	Number of students with disabilities provided special class programs in buildings/facilities attended by students with disabilities only. These buildings could be BOCES owned/leased, rented or used under other agreements.
4	Number of students with disabilities provided special class programs by BOCES, in the student’s home or in a hospital.
5	Total of Lines 1-4.

BOCES Name: ___________________________ SED Code: ______________________

Table 3
Buildings and Facilities in Which School-age Students with Disabilities
Receive Special Education Services Other than Special Class Programs Provided by a BOCES
December 1, 2004

Students Provided Special Education Services Other Than Special Class Programs by BOCES by Race/Ethnicity

(e.g., special education related services, resource room programs, consultant teacher services)

Total Number of Students Provided Special Education Services Other Than Special Class Programs by BOCES

Line
Category
A
B

C

D
E F

American Indian/ Alaskan Native Asian/Pacific Islander Black (Not of Hispanic Origin) Hispanic White (Not of Hispanic Origin)

1

Number of students with disabilities provided special educational services other than special class programs by BOCES in a public school district building/facility that is also attended by non-disabled students.

2

Number of students with disabilities provided special educational services other than special class programs in other than a public school district building/facility that is also attended by non-disabled students. These buildings could be BOCES owned/leased, rented or used under other agreements.

3

Number of students with disabilities provided special educational services other than special class programs in buildings/facilities attended by students with disabilities only. These buildings could be BOCES owned/leased, rented or used under other agreements.

4

Number of students with disabilities provided special educational services other than special class programs by BOCES, in the student’s home or in a hospital.

5

Total of Lines 1-4.

BOCES Name: ___________________________ SED Code: ______________________

Table 4
Race/Ethnicity of School-age Students with Disabilities (Ages 14-21)
Provided Special Education Services by BOCES on December 1, 2004

Directions: In Line 1, under each race/ethnicity category, enter the number of students with disabilities from Table 2 (students provided special class programs) who are between 14-21 years of age on December 1, 2004.

In Line 2, under each race/ethnicity category, enter the number of students with disabilities from Table 3 (students provided special education services other than special class programs) who are between 14-21 years of age on December 1, 2004.

Race/Ethnicity

Line
Category
A
B

C

D
E F

American Indian/ Alaskan Native Asian/Pacific Islander Black (Not of Hispanic Origin) Hispanic White (Not of Hispanic Origin) Total

1

Students with disabilities, ages 14-21 provided special class programs.

2

Students with disabilities, ages 14-21 provided special education services, other than special class programs.

3

Total of Lines 1-2.

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[_bars/f2pm.htm]	PD 1A/4A FORM CONTENTS: transmittal letter
	#Instructions and Definitions
	Table 1
	Table 2
	Table 3
	Table 4

To:	Special Education Data Managers of BOCES District Superintendents	Date: September 2004
From:	Inni Barone
Subject:	PD-1A/4A- BOCES Count of Preschool Students with Disabilities and Buildings/Facilities in which School-age Students with Disabilities Receive Special Education Programs or Services on December 1, 2004. Due between December 1, 2004 and December 17, 2004.

		Students Provided Special Education Services Other Than Special Class Programs by BOCES by Race/Ethnicity (e.g., special education related services, resource room programs, consultant teacher services)					Total Number of Students Provided Special Education Services Other Than Special Class Programs by BOCES
Line	Category	A	B	C	D	E	F
Line	Category	American Indian/ Alaskan Native	Asian/Pacific Islander	Black (Not of Hispanic Origin)	Hispanic	White (Not of Hispanic Origin)
1	Number of students with disabilities provided special educational services other than special class programs by BOCES in a public school district building/facility that is also attended by non-disabled students.
2	Number of students with disabilities provided special educational services other than special class programs in other than a public school district building/facility that is also attended by non-disabled students. These buildings could be BOCES owned/leased, rented or used under other agreements.
3	Number of students with disabilities provided special educational services other than special class programs in buildings/facilities attended by students with disabilities only. These buildings could be BOCES owned/leased, rented or used under other agreements.
4	Number of students with disabilities provided special educational services other than special class programs by BOCES, in the student’s home or in a hospital.
5	Total of Lines 1-4.

		Race/Ethnicity
Line	Category	A	B	C	D	E	F
Line	Category	American Indian/ Alaskan Native	Asian/Pacific Islander	Black (Not of Hispanic Origin)	Hispanic	White (Not of Hispanic Origin)	Total
1	Students with disabilities, ages 14-21 provided special class programs.
2	Students with disabilities, ages 14-21 provided special education services, other than special class programs.
3	Total of Lines 1-2.