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  • Pa Early Intervention Intake Fax Form - Erie County 2016

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Ame: DOB: Race: Primary Language: Living Situation: Age: yr(s) mo(s) SSN: M Gender: African Am./Black Alaskan Native Amer. Indian Asian Caucasian/White Nat. Hawaiian Pac. Islander Unknown/Other: English Arabic Hindi Mandarin Spanish Sign Language Russian Other: Family Home Foster Care Homeless Kinship Care Placement Shelter Citizenship Status: Bi-Racial Hispanic Ethnicity: Non-Hispanic Interpreter Needed: Nepali Yes US Citizen Illegal Alien Refuge.

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CONNECT Helpline: 1-800-692-7288 If you are unable to connect with your EI program, or you have difficulty starting teleintervention services, please email the Office of Child Development and Early Learning: ra-ocdintervention@pa.gov.

Services are available 24/7 by calling 1-800-692-7459.

Call the PA Independent Enrollment Broker (PA IEB) at 1-877-550-4227.

To refer someone to the program, call the Early Intervention Program at (716) 858-6161.

Early intervention means identifying and providing effective early support to children and young people who are at risk of poor outcomes. Effective early intervention works to prevent problems occurring, or to tackle them head-on when they do, before problems get worse.

The provisions of this Chapter 4226 issued under the Early Intervention Services System Act (11 P.S. § § 875-102—875-503); and section 201(2) of the Public Welfare Code (62 P.S. § 201(2)), unless otherwise noted.

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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