Tip for State-specific

You have the right to accept or decline any service listed in the IFSP

Tip for State-specific

Request a copy of the signed IFSP for your records

Tip for State-specific

The IFSP must be reviewed at least every 6 months — you can request a review sooner

Maternal & Pediatrichard

Individualized Family Service Plan (IFSP)

State-specific · State Early Intervention programs

Written plan for early intervention services for children birth to age 3 with developmental delays. Includes current levels of functioning, family concerns, expected outcomes, and services to be provided.

Form Details

Total fields: 65
Auto-fillable: 35 (54%)
Time without BeneFill: 60 minutes
Time with BeneFill: 15 minutes
Time saved: 45 minutes
Filled by: both
Frequency: annual
State-specific: Yes — form may vary by state

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Where to Submit This Form

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Developed at a meeting with the Early Intervention team

The IFSP is created collaboratively during a team meeting. Parents are required members of the team.

Filing Deadline

Must be completed within 45 days of the initial referral to Early Intervention. Reviewed every 6 months and updated annually.

Required Attachments

📎 Multidisciplinary evaluation results
📎 Parent input on family concerns, priorities, and resources
📎 Medical records and developmental assessments
📎 Insurance information (Medicaid or private, if applicable)

Processing Time

The IFSP is developed at the meeting itself. Services must begin within 30 days of the family signing the plan.

What Happens Next

A service coordinator will arrange for the services listed in the IFSP (speech therapy, occupational therapy, etc.). Services are typically provided in the child's natural environment (home, childcare).

Tips for This Form

✓ You have the right to accept or decline any service listed in the IFSP
✓ Request a copy of the signed IFSP for your records
✓ The IFSP must be reviewed at least every 6 months — you can request a review sooner
✓ Begin planning the transition to preschool services (Part B / IEP) at least 90 days before the child turns 3

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Application for WIC nutrition assistance providing education, breastfeeding support, and benefits for healthy foods. Requires proof of identity, address, income (or Medicaid/SNAP/TANF participation), and a health screening.

WIC Medical Documentation / Nutrition Risk Form

State-specific · State WIC agencies

Medical documentation of nutrition risk factors qualifying an individual for WIC, such as anemia, underweight, or high-risk pregnancy.

CHIP Application

State-specific / Healthcare.gov · State CHIP agencies

Application for Children's Health Insurance Program for families with income too high for Medicaid but too low for private coverage. Uses MAGI-based financial eligibility. Children must be uninsured.

School Entrance Health Form

State-specific (e.g., VA MCH213G) · State Departments of Health/Education

Required for school entry. Includes immunization records, health history, physical examination, and developmental screening. Must be completed no earlier than one year before school entry.

Immunization Record / Certificate of Immunization

State-specific · State Departments of Health

Official record of required childhood vaccinations for school enrollment. Exemption forms (medical, religious, philosophical) vary by state.

Medication Administration Authorization (School)

District-specific · School districts

Authorization for school nurse or designee to administer prescribed medication during school hours.

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the State Early Intervention programs or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.