Seal of Dane County County of Dane
Dane County Department of Human Services

Birth to 3 Cost Share

When a family has a child in the Birth to 3 Program, the county is required to assess the family’s ability to contribute toward the cost of these services.  This is known as the Parental Cost Share.  This process does not affect your child’s eligibility for the program or the services provided.

A Parental Cost Share is based on the family’s annual income and the number of family members residing in the family’s home.  There is a specific sliding scale for families with multiple children in Birth to 3 and/or under age 19 with a disability in the household.  The Parental Cost Share payment is one way counties are able to fund Birth to 3 services.  Additionally Birth to 3 programs can bill Medicaid and other private or employer-based health insurance plans for early intervention services. 

Parent Statement of Income

The Parent Statement of Income (PSI) form is the responsibility of the parent/guardian and requests information needed by counties to calculate a possible Parental Cost Share.  If the form is not returned completely, the full cost of early intervention services could be billed to your family.  A cost share cannot exceed $1,800 annually.

There are possible considerations for reducing a cost share you can discuss with your service coordinator if the cost share amount is prohibitive for your child to receive Birth to 3 services.

Your cost share can change if:

  • Your family income changes.
  • The number of family members in your household changes.

Any changes in the above scenarios should be communicated to your service coordinator.  Your service coordinator can assist with the completion of a new PSI form.

Your service coordinator or the Birth to 3 agency will not have access to the information on your Parent Statement of Income.  The completed form is sent directly to Dane County Human Services.  Dane County Human Services calculates the cost share by using your Parent Statement of Income and the State of Wisconsin’s cost share tables to determine your family’s adjusted annual income and the annual cost share amount.

Completed PSI forms can be mailed directly to the Collections Unit using the postage-paid self-addressed envelope from your service coordinator or via email to


Parents/Guardians receive a monthly cost share billing statement from Dane County Collections Unit after your child’s qualified early intervention services begin.  For families participating in other public benefit programs, e.g. CLTS, CCOP, FoodShare, W-2, SSI etc., there is no cost share.

Click here to see an example of a Birth to 3 cost share billing statement.

Dane County can accept cash, checks, and credit card payments.  Payments, completed PSI forms, Birth to 3 Cost Share inquiries, payment options, and other general questions related to Cost Shares can be directed to:


Fax: (608) 242-6363

US Mail:

        Dane County Human Services

        Attn: Collections Unit

        1202 Northport Dr

        Madison WI 53704