Skip to main content
Oregon.gov Homepage

EIECSE Forms EI Eligibility (Birth - 3)

All forms are in word format

Statement of Eligibility - Developmental Delay EI (B-3)  581-5149C-X

Statement of Eligibility - Physical or Mental Condition EI (B-3) (Cross-referenced under Medical Statements) 581-5150d-P

Statement of Eligibility - Vision Impairment EI (B-3) 581-5148E-X2

Statement of Eligibility - Hearing Impairment EI (B-3) 581-5148F-X2

Statement of Eligibility - Orthopedic Impairment EI (B-3) 581-5148H-X2

Statement of Eligibility - Autism EI (B-3) 581-5148L-X2 

Statement of Eligibility - Deaf Blind EI (B-3) 581-5148M-X2 

Statement of Eligibility - Traumatic Brain Injury EI (B-3) 581-1439-P

Your browser is out-of-date! It has known security flaws and may not display all features of this and other websites. Learn how

×