Referral Process). If the IEP team determines the student has a low incidence disability and that the student requires low incidence equipment, then the LEA must complete the appropriate Low Incidence Pre-Approval/Reimbursement Request form, D/M 86C. This form shall also be completed if the IEP team determines and documents the need for home use of the low incidence equipment. 1. Low Incidence Pre-Approval/Reimbursement Request (D/M 86A): Purchase(s) made by the LEA then reimbursed through low incidence funds For all low incidence equipment other than mobile computing devices and device applications, complete SELPA form D/M 86A and have the LEA Special Education Director/Coordinator sign the form. Attach a copy of the student’s current IEP documenting the student’s disability and need of the low incidence equipment, any additional information regarding the equipment to be purchased, a completed purchase order with SELPA form D/M 86A and submit all documents to the SELPA office. After SELPA approval, the LEA will be responsible for purchasing the equipment and ensuring the assigned low incidence equipment inventory tags are properly placed on the equipment. After the LEA has purchased and received the equipment, the LEA may seek reimbursement through low incidence funding by completing section 2 of form D/M 86A and forwarding the request to the SELPA (refer to Section C). 2. Low Incidence Pre-Approval Request for Mobile Computing Device (D/M 86B): Purchase(s) made by the SELPA LEAs complete SELPA form D/M 86B if the request is specifically for a mobile computing device (i.e., iPad, computer tablet). This form and any additional information regarding the equipment must be sent to the SELPA office for approval. The SELPA will be responsible for purchasing the mobile computing device and device application(s), assigning the low incidence equipment/ID number, downloading the device application(s), and coordinating the delivery and release of the equipment to the LEA. The LEA is responsible for notifying the student’s teacher(s) of their responsibilities for the use of low incidence equipment (refer to Appendix B). Section C – How to Request Reimbursement The SELPA reimburses member LEAs for low incidence equipment based on the availability of funds. All purchases of low incidence equipment during a fiscal year (July 1 – June 30) must be submitted by August 30th, following the school year the request was made. Member LEAs shall submit approved requests for reimbursement in the following manner: 1. Complete/submit Section 2 of SELPA Form D/M 86 – Low Incidence Pre- Approval/Reimbursement Request Form; and 2. Submit a copy of the request form with a copy of the purchase order and copy of the vendor’s paid invoice to the SELPA Business office.
Appendix B, Chapter 13 – Low Incidence Funding, Desert/Mountain SELPA As of 9/17/2018 CAHELP Governance Council Review/Approval
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