Submission Requirements for Private Placement Reimbursement

Submission Requirements For Placements In Approved Private Schools, Special Act School Districts, State Operated Schools and State-Supported Schools for Students with Disabilities (Ages 5-21)

Scenario	Submit funding approval form?	Submit STAC-1?
Change in CSE only –Private Day	Yes	Yes
Change in CSE Only – Residential	Yes	Yes
Change from Residential to Private Day	Yes	Yes
Change from Private Day to Residential	Yes	Yes
Change in Private Day schools -same year as initial placement	No	Yes
Change in Private Day schools - not same year as initial placement	Yes	Yes
Change in Residential schools - same year as initial placement	No	Yes
Change in Residential schools - not same year as initial placement	Yes	Yes
State Supported (4201) Schools	A PHC10 form is submitted prior to evaluation by the school	Yes (Applications for Commissioner's Appointment to Attend a 4201 State-Supported School is submitted along with STAC-1 form)
State Operated Schools at Rome and Batavia	A PHC10 form is submitted prior to evaluation by the school	Yes
All other Day placements	Yes	Yes
All other Residential placements	Yes	Yes

Electronic or two-page paper form to be submitted within six business days of CSE review date. Applications not filed within this timeframe will, when approvable, be effective the date of the initial filling. Form is not to be mailed if successfully submitted electronically. Schools will be notified of an approval or request for additional information within 15 business days of receipt of the two-page application. Electronic filers will immediately receive error messages or notice of successful transmission on their computer screens as part of the electronic filing.

STAC-1 forms for Out-of-State placements must be accompanied by Statement of Assurance for Students in Out-of-State Placements form.

Prior to receiving approval for reimbursement for a school-age (5-21) student placed in an approved private schools or Special Act School District, a Committee on Special Education (CSE) review must be conducted in accordance with the requirements of Sections 200.4 and 200.6 of the Commissioner's regulations. For information regarding electronic filing contact the STAC and Special Aids Unit

Approved Private Schools, Special Act School Districts, State Operated Schools and State-Supported Schools for Students with Disabilities (Ages 5-21)	New York State List of Approved Private Schools, Special Act School Districts, State Operated Schools and State-Supported Schools for Students with Disabilities. These school-age programs are listed alphabetically, geographically and by disability served and link to general information regarding each school.
Residential Program Information and Matches	Residential school-age programs in approved private schools and special act districts are listed alphabetically and by disability. Programs are also listed by student needs served and link to more specific information regarding student profiles served and services offered.