Guide for Completing **School Age** Request for Reimbursement for Student-Specific Nurses, Interpreters, Maintenance Aides & Out-of-State Education Aides

Since the introduction of the Aide Percentage box on most service approval screens, most school age student-specific aides no longer require this form. This form should only be submitted when at the aide is:
  • A student-specific LPN, RN, or Interpreter
  • Assigned to a student in a residential placement, outside of education hours
  • Assigned to a student placed out of state

Student and School District Information

Data Fields Description
STAC ID Enter the 6-digit student STAC ID#, if known.
Student Name Enter the student’s full name. (Required)
Date of Birth (mm/dd/yy) Enter the student’s date of birth. (Required)
Name of School District with CSE Responsibility Enter the name of the school district with CSE responsibility for the student's special education services. Please be specific. (Required)
School District SED Code Enter the 12-digit SED Code of the school district with CSE responsibility for the student's special education services. (Required)

School Age Education Placement

Data Fields Description
Education Provider Name Enter the name of the education service provider. Please be specific. (Required)
(For BOCES, indicate which BOCES.)
Education Provider SED Code Enter the 12-digit SED Code of the education service provider. (Required)
Program Name Enter the name of the education program the student attends. Please be specific.
Program Code Enter the 5-character STAC education program code, if known. For students continuing at the same provider AND in the same program as the previous year, use the same program code as that year. Examples: 9000-A, 9001-B,  9000-I.
Program Runs Hours/Day Enter the number of hours the program runs per day. (Full-day special classes usually run 5 to 6 hours.) (Required)
Program Runs Days/Week Enter the number of days the program runs per week. (Required)
Student Attends Hours/Day Enter the number of hours per day the student is in attendance. For students enrolled with an aide full-time, this number should match the hours/day the program runs. (Required)
Student Attends Days/Week Enter the number of days per week the student attends the program. For students enrolled with an aide full-time, this number should match the hours/day the program runs. (Required)

Aides/Nurses/Interpreters During Education Hours

Check the box for each type of student-specific support personnel assigned to the student. Complete the following fields for each personnel type:
Data Fields Description
Requested Start Enter the date the support personnel is expected to begin, in MM/DD/YY. (Required)
Requested End Enter the date the support personnel is expected to end service as per the student's IEP. (Required)
Hours 1:1 Requested Enter the number of hours per day that the student requires student-specific support personnel during education hours as per the student's IEP. (Required)
Days 1:1 Requested Enter the number of days per week the student requires student-specific support personnel during education hours as per the student's IEP. (Required)
Shared by multiple students Indicate whether the student-specific support personnel is shared by multiple students during the time period the student specific support personnel is working with this student. If it is, enter the number of students. (Required)

Note: When the student-specific personnel is for less than the full time period of service entered on the original STAC record, two STAC records will be created -- one with aide services/rates indicated and one without aide services/rates indicated.

Aide Wage Info (For Maintenance & Out of State Education)

Data Fields Description
Salary & Fringe Benefits (Per Hour) If the aide is assigned to a student outside of educational hours, or if the aide is assigned to a student state, enter hourly cost of the aide's salary and fringe benefits.

School Age Maintenance Placement

Data Fields Description
Maintenance Provider Name Enter the name of the maintenance service provider. (Required)
Maintenance Provider SED Code Enter the 12-digit SED Code of the maintenance service provider. (Required)
Program Name Enter the name of the maintenance program the student attends. Please be specific.
Program Code Enter the 5-character STAC maintenance program code, if known. For students continuing at the same provider AND in the same program as the previous year, use the same program code as that year. Examples: 9265-A, 9266-B, 9265-I.

Maintenance Aides Outside Education Hours

Data Fields Description
Requested Start Enter the date the 1:1 is expected to begin as per the student's IEP. (Required)
Requested End Enter the date the 1:1 is expected to end service as per the student's IEP. (Required)
Hours 1:1 Requested
(Monday through Friday):
Enter the number of hours per day the student requires 1:1 services during residential hours during the school week as per the student's IEP.
Hours 1:1 Requested
(Saturday & Sunday):
Enter the number of hours per day the student requires 1:1 services during residential hours over the weekend as per the student's IEP.
Shared by multiple students Indicate whether the 1:1 is shared by multiple students during the time period the student specific support personnel is working with this student. If it is, enter the number of students. (Required)

Note: When the aide begins after the student's maintenance start date or ends service before the student's maintenance end date, two STAC records will be created – one with 1:1 services/rates indicated and one without 1:1 services/rates indicated.

Additional Notes

Note 1: 10-Month Public Excess Cost Placements: For students who attend district or BOCES programs and require 1:1 services as per the student's IEP, please note that 1:1 request forms are not required. The annualized cost for the 1:1 should be included in the total cost for special education services entered on the STAC. Requests received for students in these placements will be disregarded.

Note 2: Please review the List of Schools for Which No 1:1 Aide Requests Will Be Processed. The tuition rates set by SED for those programs have been adjusted to include the cost for 1:1 services, thereby eliminating separate 1:1 add-on rates.

Note 3: Requests for RN, LPN, or Interpreter at those schools for which no 1:1 aides are allowed should continue to be submitted for processing, as 1:1 RN, LPN, and Interpreter rates continue to be in effect for these services.

Note 4: No 1:1 maintenance aide requests will be processed for students in Hard-to-Place (HTP) in-state maintenance programs.

Upload completed and signed aide request forms to the SED File Transfer Manager.

Once a form has been uploaded, send a notification email to OMSSTAC@nysed.gov. Indicate in the body of the email your 12-digit SED Code and the name of the file(s).

Last Updated: December 13, 2022