Instructions

U.S. DEPARTMENT OF HEALTH and HUMAN SERVICES
Office of Child Support Enforcement

OMB APPROVED

DRAFT

Control No. 0970-0181
Expires: 09/30/2010

CHILD SUPPORT ENFORCEMENT PROGRAM EXPENDITURE REPORT
PART 1: QUARTERLY REPORT OF EXPENDITURES and ESTIMATES
State:

Current (Claiming)

Next (Estimating)

Quarter Ended:

Quarter Ending:

Current Quarter Claims
(A) Total
(B) Federal Share

SECTION A.

Mark
Box:

Prior Quarter Adjustments
(C) Total
(D) Federal Share

Initial Report
Rev'd Report

Next Qtr. Est.
(E) Total

EXPENDITURES

1a. Admin Costs:
IV-D (0% FFP)

$

$

1b. Admin Costs:
$

$

$

$

$

IV-D (66% FFP)........ $

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$
Total Costs
Claimed............. $

$

$

$

$

$

$

$

$

IV-D (66% FFP)

1c. Adm Costs: Non
2a. Fees and Costs
Recov'd (66% FFP) $

2b. Interest, Other
Income (66% FFP) $

3. Net Admin.
Costs

4. ADP Developm't
with APD Req'd

5. ADP Operational
with APD Req'd

6. Other ADP
w/o APD Req'd

7

SECTION B.

INCENTIVE PAYMENTS / FEDERAL SHARE / FEES FOR SERVICES

8

Est. Incentive
Payment

9

Fed Share of
IV-A Collect.

10
11
12

Amt. from OCSE-34A
Line 10b, Col G ==>
Fees:
Enter Total Fee in
Federal FPLS... Column B ===>
Fees:
Enter Total Fee in
CSENet............ Column B ===>
Fees:
Enter Total Fee in
Pre-Offset Svc.. Column B ===>
Enter Total Amount in
Adjustments
Column B ===>

$

$

$

$
$
$

13
$
14 Net Fed Share
of Expenditures..
$
15 State Share
Enter State Share Only
of Expenditures.. in Column B ===>
$

Enter State Share Only
in Column D ===>

$

$

$

$

This certifies that the information on this form is accurate and true to the best of my knowledge and belief. This also certifies
that the State share of expenditures estimated for the Next Quarter are, or will be, available as required by law.
Signature, IV-D Agency Director

Signature, Approving State Official
Date:

Typed Name, Title, Agency

Form OCSE-396A - Part 1 (10/01/2007)

Date:
Typed Name, Title, Agency

Replaces 10/01/2003 version, now obsolete.

mhb

U.S. DEPARTMENT OF HEALTH and HUMAN SERV
Office of Child Support Enforcement

OMB APPROVED

DRAFT

Control No. 0970-0181
Expires: 07/31/2010

CHILD SUPPORT ENFORCEMENT PROGRAM FINANCIAL REPORT
PART 2: PRIOR QUARTER EXPENDITURE ADJUSTMENTS
State:

Current
Quarter Ended:

(A) Total
Adjustment

(B) Federal Share
of Adjustment

(C) Funding
Category *

(D) Applicable to
Fiscal Quarter Ended

Mark
Box:

Initial Report
Revised Report

(E) Federal Audit Number (if any)
Other Comments

SECTION A: INCREASING ADJUSTMENTS
$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

<=== TOTAL INCREASING ADJUSTMENTS

SECTION B: DECREASING ADJUSTMENTS
$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

<=== TOTAL DECREASING ADJUSTMENTS

$

$

<=== NET ADJUSTMENTS (Section A Totals minus Section B Totals)

* Funding Categories:

(with equivalent line numbers from Part 1):

CEN - Administrative Costs Using Incentive Payments (0% FFP Rate): Line 1a.
LAB - Laboratory Costs (90% FFP Rate - Pre FY 2007 costs only): Line 1b
ADM - Administrative Costs (66% FFP Rate): Lines 1b and 1c
INC - Program Income from fees, interest, etc. (66% FFP Rate): Lines 2a and 2b
DEV - CSES Developmental Costs with an Approved Advanced Planning Document (APD) (66% FFP Rate): Line 4
OPN - CSES Operational Costs with an Approved Advanced Planning Document (APD) (66% FFP Rate): Line 5
ADP - CSES Costs where an Approved Advanced Planning Document (APD) is not required (66% FFP Rate): Line 6

Form OCSE-396A - Part 2 (10/01/2007)

Replaces 10/01/2003 version, now obsolete.

mhb