OCFS-3440 (6/2015)

Appendix I

NEW YORK STATE

OFFICE OF CHILDREN AND FAMILY SERVICES

COMMISSION FOR THE BLIND

INDIVIDUAL SERVICE PLAN

This plan was developed with you for your child on the basis of diagnostic information which indicates that he/she is legally blind. Your child's plan may change as a result of new information or circumstances.


To help your child in achieving his/her goal(s), New York State Commission for the Blind (NYSCB) will provide the following:


Portions of this plan are subject to availability of Non-VR funds and the availability of similar benefits. This plan will be reviewed with you at least annually.

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Your rights include the following:

It is your right to be fully involved in the development of your child's plan.

It is your right to be consulted before your child's case is closed.

If your child's case is closed on the basis of ineligibility, you will have the opportunity to be involved in the decision.

If you are dissatisfied about your child receiving or being denied services under this plan, you are encouraged to discuss this with the Children's Consultant.

If you are still dissatisfied, you may request an initial review.

All personal information furnished for your child's rehabilitation will be held confidential. You may, however, be asked to waive confidentiality in accordance with established policy and procedure.

Your responsibilities are:

To cooperate in carrying out this plan.

To keep the Children's Consultant advised of any changes which affect your child's plan such as change in:

Health

Medical Insurance

Telephone

Address

Other Benefits Available

I have reviewed this program an am in agreement with it.

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