Request for STAC Forms

The following STAC forms are available in PDF format. Click on the form link below.

• Preschool STAC-1 - Preschool Request for Commissioner's Approval of Services for students with Disabilities
• Preschool 1:1 Aide - Preschool Request for Reimbursement for Partial 1:1 Aide, 1:1 Nurse, 1:1 Interpreter
• School Age STAC-1 - School Age Request for Commissioner's Approval of Services for students with Disabilities
• School Age 1:1 Aide - School Age Request for Reimbursement for Part-Time/Shared 1:1 Aides and 1:1 RN, 1:1 LPN, 1:1 Interpreters f/t Deaf
• STAC-202 - (DSS) Designation of School District of Attendance for Children in Temporary Housing
• STAC-4 - Request for Commissioner's Approval of Services for Children in Temporary Housing
• STAC-5 - Request for Commissioner's Approval of Reimbursement for Evaluations.
• Rates Exceeding $85,000 - High Cost Student Data Report for Students with 10-month Education Rates of $84,999+
• Rates Exceeding $95,000 - High Cost Student Data Report for Students with 10-month Education Rates of $94,999+
• Summer Transporation Cost Exceeding $5,000/$5,500 - Summer Transportation Costs Exceeeding $5,000/$5,500+

The STAC-200's listed below are a five-part form and therefore need to be mailed. To request these forms please contact the STAC, Special Aids and Medicaid Unit by phone (518) 474-7116, fax (518) 402-5047 or email omsstac@mail.nysed.gov

• OMRDD STAC-200 - Notice of Other State Agency (OMRDD) Placement of Children with Handicapping Conditions.
• OCFS & OMH STAC-200 - Notice of Other State Agency Placement of Children with Handicapping Conditions