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

TX HHS Form 4201: ECI Surrogate Parent Identification of Need and Assignment is a crucial document used to identify situations where a surrogate parent is necessary for a child receiving Early Childhood Intervention (ECI) services. This form helps solve the problem of assigning a responsible individual to represent the child's interests in matters related to their evaluation, assessment, Individualized Family Service Plan (IFSP), and ongoing early intervention services.

The form requires the completion of a worksheet on the back to verify the need for a surrogate parent. The reasons for needing a surrogate parent include situations where a parent cannot be identified, unable to locate a willing and able parent, or when a child is a ward of the state with no individual foster parent appointed. Key sections of the form include the reason for need, Surrogate Parent Information and Certification, and the signature section.

This form should be used in situations where it is necessary to assign a surrogate parent to represent the interests of a child receiving ECI services. The criteria for surrogate parents are outlined in 34 CFR Section 303.422. By completing this form, professionals can ensure that the needs of the child are adequately represented and that the assignment of a surrogate parent is done in accordance with the regulations.