Attached is a PD-3A/4 form to be used to report your count of pre-school and school-age students with disabilities provided special education programs and services on December 1, 2004. This report also requests the settings in which students with disabilities are provided special education services. This report is due in the State Education Department between December 1, 2004 and December 17, 2004 and should be submitted to:

To be counted in this report, each student with a disability, on December 1, 2004, must meet the following criteria:

• The student must be receiving special education programs and services in the State agency’s education program or in a program in which the student is placed by the State agency. Services provided must be in accordance with the student’s Individualized Education Program (IEP) and in accordance with State standards. A student with a disability whose placement in your agency is discontinued before December 1, 2004, may not be included in the count for your agency. A student who is initially placed in your agency and provided special education after December 1, 2004 may not be included in the count for your agency.

Federal law and regulation require that state agencies ensure an unduplicated count of students with disabilities. Before submitting the PD-3A/4 report, please complete local verification procedures to ensure that each student is counted only once. Such verification procedures may include visual scans, computer scans or other methods; and are especially important for agencies with multiple sites where students receive special education programs and services.

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 review for your agency, please maintain a list (hard copy or other readily retrievable format) of all students included in this child count until June 30, 2011. Upon completing local verification procedures, if it is determined that one or more counts are incorrect, a revised report (i.e., PD-3A/4 form) must be submitted to SED.

Compared to the PD-3A/4 report for 2003-2004, the PD-3A/4 report for 2004-2005 has been modified in the following ways:

• Section A, Table 1 has been modified to collect information on preschool children with disabilities ages 2-4, not 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 Sections B and C, not in Section A.

• Some instructions or explanatory notes are added to provide clarifications.

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 disproportionality

• 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 call 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

*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 New York State students with disabilities served on December 1, 2004. I further certify that the students reported were served in accordance with their Individualized Education Programs and in accordance with State standards.

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

1. Wherever information is requested regarding students' race/ethnicity, please use the following definitions to assist you in determining the most appropriate category for reporting students:
   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.

2. Wherever students are to be reported by age, please report age as of December 1, 2004.

3. If specific instructions for some tables are not provided below, they are included with each table of the PD-3A/4 form.

Section C, Reports 1-14: There are two tables for each disability category- Table 1 and Table 2. These tables request placement information for all school-aged students with disabilities, ages 4-21, who are the responsibility of your CSE and are provided school-age special education programs and services on December 1, 2004.

Table 1: Report the number of students with disabilities who are educated in regular school buildings and removed from regular classes for "Less than 20%", "21% to 60%", or "More than 60%" of the school day or school week. "Regular school buildings" are buildings for both disabled and non-disabled school-age students. "Regular classes" are classes for both disabled and non-disabled school-age students. Time outside of regular classroom is a measure of the extent of removal from the regular classroom setting, NOT of the total amount of special education services provided. It is the percent of each school day or week that a student receives special education including related services, apart from non-disabled students while within a regular school building. For purposes of these data collection, students in the following settings should be reported in Table 1 (regular school buildings):

In order to determine the percent of time students receive services outside regular classrooms (i.e., in rooms/groupings attended by students with disabilities only), it is important to consider where the service is provided rather than the type of service which is provided. To calculate the percentage of time outside the regular classroom, divide the number of hours the student receives special education and related services outside the regular classroom each day or week by the total number of hours in the school day or school week. Use the length of the entire school day, including all periods and lunch. The following examples are provided for purpose of clarification:

Table 2: Report the number of students with disabilities who are educated in separate educational settings. These are settings that are attended by students with disabilities only. The definition of each separate educational setting follows:

Special Public Day Schools- These schools include public school district or BOCES buildings that are attended by students with disabilities only. These schools also include Special Act School Districts if they are attended on a day school basis, and if they include students with disabilities only.
Special Private Day Schools- Approved private schools for students with disabilities that are attended by students with disabilities only, on a day basis.
Public Residential Facility- A public facility in which students reside and attend an education program affiliated with the agency, in buildings that serve only students with disabilities. If students with disabilities receive educational services in State agency buildings that are attended by both students with and without disabilities, they must be reported in Table 1.
Private Residential Facility- A private facility in which students reside, and attend an education program operated by the agency, in buildings that serve only students with disabilities. If students with disabilities receive special education services in buildings that include disabled and non-disabled students, such students are to be reported in Table 1.
Home- Use this setting if the State agency’s Committee on Special Education has determined that the most appropriate educational placement for the student is in the student’s residence (or "home"), and not in a school setting.
Hospital or Other Non-School- These are settings in which students with disabilities are provided special education services based on their unique needs.

Directions: Please review directions and definitions for completing reports 1-14 beginning on page 2. The total number of students reported in reports 1-13 and in reports 15 and 16 must be equal to the total number of students reported in Section B, Table 1, Line 1.