NEW YORK STATE DEPARTMENT OF HEALTH State Disability Review Unit Questionnaire of School Performance Childs Name: (Last, First, Middle) Case Number: Date of Birth: Agency: Client ID Number: Disability.
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How to fill out the Doh 5152 online
The Doh 5152 form, also known as the Questionnaire of School Performance, is essential for assessing a child's eligibility for disability benefits. This guide provides a clear and structured approach to completing the form online, ensuring that you provide the necessary information to support the evaluation process.
Follow the steps to complete the Doh 5152 form effectively.
- Click ‘Get Form’ button to access the Doh 5152 form and open it in your preferred form editor.
- Begin by entering the child’s name in the designated field, ensuring you include the last name followed by the first and middle names if applicable.
- Next, input the case number assigned to the child's application for benefits.
- Fill in the date of birth for the child in the specified field.
- Indicate the relevant agency handling the case, as specified in the guidelines.
- Enter the client ID number and the disability ID number if available.
- Select the child's sex by marking either Male or Female.
- Provide your name and contact number for further assistance at the State Disability Review Unit.
- Complete the section on the child's current school grade or education level.
- Indicate the class size in which the child is currently enrolled.
- If the current grade level is not age-appropriate, briefly describe the reason for the child's placement in that grade.
- Answer questions regarding the child's behavior, specifically focusing on frustration tolerance, social interactions, and self-care activities. Include examples and frequency if applicable.
- Provide any other observations that could assist in evaluating the child’s performance and behavior.
- After completing all sections, ensure you sign and date the form where indicated.
- Finally, save your changes, download, print, or share the completed form as needed.
Complete and submit your Doh 5152 form online to ensure accurate processing of your application.
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