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FIRST STEPS PART C ELIGIBILITY DETERMINATION STATEMENT State Form 50054 (R / 1004) / BCD 0076 County Date (month, day, year) Name of person completing this form Title Name of child Date of birth (month,
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First Steps Part C is a program that provides early intervention services for infants and toddlers with disabilities or developmental delays.
Parents or legal guardians of infants and toddlers who may be eligible for early intervention services are required to file First Steps Part C.
To fill out First Steps Part C, parents or legal guardians can contact their local Early Intervention program or visit their state's Department of Health website for more information.
The purpose of First Steps Part C is to ensure that infants and toddlers with disabilities or developmental delays receive appropriate early intervention services to support their development.
First Steps Part C requires information about the child's developmental status, any diagnosed disabilities or delays, and the services needed for the child's development.
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