Phone (419) 784-5136 | Address: 1933 E 2nd Street Defiance, Ohio 43512


Head Start/Early Head Start staff will comply with the Social Security Administration Request for Administration Information records form.


The Disabilities/Intervention Specialist, after reviewing the documentation will:

  1. Answer the questionnaire when appropriate and/or
  2. Share with other appropriate Head Start staff members to complete the questionnaire, including but not limited to:
    1. Teaching Staff/Home Visitor
    2. Site Managers
    3. Family Advocate
  3. Fax the completed questionnaires back to the appropriate SSI office named on the documents.
  4. Record is filed in child’s permanent record by following all HIPAA and FERPA rules.


Forms and Additional Guidance:

This policy complies with the following

Head Start Program Performance Standard:    
ODJFS Child Care Manual:    
CACFP Regulation:    
Caring for Our Children:    
Other Sources: 


Effective Date:   8/7/17 Revision Date:   3/17/20
Approved By Policy Council:   8/7/17 Revision Approved By Policy Council: