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D Contact Information Child Name: If the child is known by another name enter it here: Date of Birth: / / Child Age: Gender: M F Race: Street Address: City: State: Zip: County: Type of Insurance Coverag.

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What is ECI? Early Childhood Intervention (ECI) is a statewide program within the Texas Health and Human Services Commission for families with children birth up to age 3, with developmental delays, disabilities or certain medical diagnoses that may impact development.

EIP is available to all families in New York City regardless of income or immigration status. There is no cost to families. Your health insurance, including Medicaid, may be used to pay for Early Intervention services, at no direct cost to you or impact on health benefits.

Families, doctors, and community members can make a referral by: Calling 311 and asking for Early Intervention. Completing the Early Intervention Program Referral Form (Fillable PDF) and faxing it to a regional office in the family's home borough.

In New York City, children with developmental delays and disabilities under three may receive these supports through Early Intervention (EI), run by the Department of Health and Mental Hygiene (DOHMH).

Health care providers should make referrals by calling 311 and asking for Early Intervention, or by filling out the Early Intervention Program Referral Form (PDF) and faxing it to the regional office in the child's borough of residence.

A referral to ECI can be based on professional judgment or a family's concern. A medical diagnosis or a confirmed developmental delay is not needed to refer. As soon as a delay is suspected, children may be referred to ECI, even as early as birth.

To be eligible for services, children must be under 3 years of age and have a confirmed disability or established developmental delay, as defined by the State, in one or more of the following areas of development: physical, cognitive, communication, social-emotional, and/or adaptive.

Early intervention services can change a child's developmental path and improve outcomes for children, families, and communities. Help your child, help your family! Families benefit from early intervention by being able to better meet their children's needs from an early age and throughout their lives.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232