TX HHS Form 4201. ECI Surrogate Parent Identification of Need and Assignment

The TX HHS Form 4201, ECI Surrogate Parent Identification of Need and Assignment, is a crucial document that helps identify the need for a surrogate parent in early childhood intervention (ECI) services. This form is used to verify the necessity of assigning a surrogate parent when a natural parent is unable or unwilling to serve as the child's representative.

This form requires the completion of a worksheet on the back, which must be fully completed before proceeding with the surrogate parent assignment process. The criteria for surrogate parents are outlined in 34 CFR Section 303.422. Key features of this form include the selection of applicable reasons for need, such as an unidentified parent or inability to locate a willing and able parent. Additionally, the form requires the signature of the ECI professional and certification that they meet specific criteria to serve as a surrogate parent.

The TX HHS Form 4201 is used in situations where a child's needs cannot be adequately represented by their natural parents. This form helps ensure that the child receives necessary services and support. Key points to note include:

• Verification of need for a surrogate parent
• Completion of worksheet on back of form
• Certification of ECI professional's eligibility to serve as a surrogate parent
• Selection of applicable reasons for need