CFS-101, Part III Attachment B
U.S. Department of Health and Human Services OMB Approval #0980-0047
Administration for Children and Families Approved through July 31, 2011
Note: Federal funds for the most of the programs identified above are awarded to States or Tribes on a yearly basis, but may be spent over a two-year period ending on September 30 of the year following the year in which they were awarded. For example, the FY 2009 grant allocation has an expenditure period from October 1, 2008 to September 30, 2010. Therefore, any fiscal year 2009 funds must be obligated during that two-year period of time and subsequently reported on this form.
Most figures in the "estimate" column can be found in a State's/Tribe's previously approved CFS 101, Part I for the fiscal year being reported on.
1. State or ITO: Enter the name of the State or Indian Tribal Organization (ITO).
2. EIN: Indicate the Employer Identification Number (EIN).
Address: Enter the address of the State or ITO Agency.
Submission: Indicate if this is a new or revised expenditure report.
Total title IV-B, subpart 1 funds: Indicate the estimated expenditures, and actual expenditures of title IV-B, subpart 1 Federal funds for the designated fiscal year for Child Welfare Services. (The estimated expenditure total should equal the amount of the grant awarded for the designated fiscal year.) Indicate as accurately as possible, the number of individuals and the number of families served, the population served, and the geographic area where services were provided. The required 25% match should not be reflected on this form.
a) Specify the estimated allotment and actual expenditures of title IV-B, subpart 1 funds for administration. Note that administrative costs may not exceed 10% of the title IV-B, subpart 1 total expenditures.
Total title
IV-B, subpart 2 Promoting Safe and Stable Families (PSSF) funds:
Indicate the estimated expenditures, actual expenditures of title
IV-B, subpart 2 funds for the designated fiscal year for Promoting
Safe and Stable Families services. (The estimated expenditure total
should equal the amount of the grant awarded for the designated
fiscal year.) The required 25% match should not be reflected on
this form.
a) Indicate the estimated allotment and actual expenditures of title IV-B, subpart 2 PSSF funds for the designated fiscal year for Family Preservation Services. Indicate as accurately as possible, the number of individuals and the number of families served,1 the population served,2 and the geographic area where services were provided.3 Note that these funds may be spent over a two-year period ending on September 30 of the fiscal year following the year in which they were awarded.
b)
Indicate the estimated and actual expenditures of title IV-B, subpart
2 PSSF funds allotted for the designated fiscal year for Family
Support Services. Indicate as accurately as possible, the number of
individuals and the number of families served, the population served,
and the geographic area where services were provided. Note that
these funds may be spent over a two-year period ending on September
30 of the fiscal year following the year in which they were awarded.
c) Indicate the estimated and actual expenditures of
title IV-B, subpart 2 PSSF funds allotted for the designated fiscal
year for Time-Limited Family Reunification Services. Indicate as
accurately as possible, the number of individuals and the number of
families served, the population served, and the geographic area where
services were provided. Note that these funds may be spent over a
two-year period ending on September 30 of the fiscal year following
the year in which they were awarded.
d)
Indicate the estimated and actual expenditures of title IV-B, subpart
2 PSSF funds allotted for the designated fiscal year for Adoption
Promotion and Support Services. Indicate as accurately as possible,
the number of individuals and the number of families served, the
population served, and the geographic area where services were
provided. Note that these funds may be spent over a two-year period
ending on September 30 of the year following that in which they were
awarded.
e) Indicate the estimated and actual expenditures
of title IV-B, subpart 2 PSSF funds allotted for the designated
fiscal year for other service related activities (e.g. planning).
Note that these funds may be spent over a two-year period ending on
September 30 of the fiscal year following the year in which they were
awarded.
f) Indicate the estimated and actual expenditures of title IV-B, subpart 2 PSSF funds allotted for the designated fiscal year for administrative costs. Note that these funds may be spent over a two-year period ending on September 30 of the fiscal year following the year in which they were awarded. Beginning in FFY 2008, States’ administrative costs may not exceed 10% of the total expenditures for title IV-B, subpart 2. (This limitation does not apply to Tribes.)
7. Total title IV-B subpart 2, Monthly Caseworker Visit (MCV) Funds (States only): Indicate the estimated and actual expenditures allotted for the designated fiscal year. Note that with the exception of FY 2006 grants, these funds may be spent over a two-year period ending on September 30 of the fiscal year following the year in which they were awarded.
a). Indicate the estimated and actual expenditures of title IV-B, subpart 2 Monthly Caseworker Visit funds allotted for the designated fiscal year (States only). Note that these funds may be spent over a two-year period ending on September 30 of the fiscal year following the year in which they were awarded. Beginning in FFY 2008 total administrative costs may not exceed 10% of the total expenditures for MCV.
8. Chafee Foster Care Independence Program (CFCIP) Funds: Indicate the estimated and actual expenditures of CFCIP funds allotted for the designated fiscal year for independent living activities as provided in the APSR or CFSP Program Instruction.
a) Indicate the estimated and actual expenditures of the State's or Tribe’s allotment for the designated fiscal year for room and board for eligible youth (not to exceed 30% of CFCIP funds). Note that these funds may be spent over a two-year period ending on September 30 of the fiscal year following they year in which they were awarded. Indicate as accurately as possible, the number of clients served, the population served, and the geographic area where services were provided.
Total funds allotted under Section 477 for the Education and Training Vouchers (ETV) Program: Indicate the estimated and actual expenditures of Education and Training Voucher funds allotted for the designated fiscal year as provided in the annual Program Instruction on the APSR or CFSP. Indicate as accurately as possible, the number of clients served, the population served, and the geographic area where services were provided.
Certification: This report must be signed and dated in the
spaces provided. The signature and title must be included of the
official of the State agency, or Indian Tribal Organization, with
authority to administer or supervise the administration of title
IV-B, subparts 1 and 2 programs and, for States only, MCV and CAPTA
programs.
By signing this form the State/Tribal official
certifies that all figures provided here are accurate.
* Title IV-B, subpart 2 includes both the Promoting Safe and Stable Families Program and the Monthly Caseworker Visit Program.
1 Report, as accurately as possible, the number of clients served per service/activity for the amount of funds expended. Indicate the number of individuals and the number of families served as labeled in the column.
2 Indicate the population that has received the designated services. This may include a range of vulnerable populations such as children at imminent risk of placement, all children in foster care, families with children returning home following placement, all eligible children, eligible children under 21 years, or eligible children requiring treatment, families with a child abuse or neglect investigation, children in contracted care, and/or families in crisis.
3
Indicate the number and type of areas identified
within the State where services are to be provided for each program.
Areas may include specific regions, counties, cities, reservations,
communities, census tracts, or neighborhoods.
| File Type | application/msword |
| File Title | Instructions |
| Author | USER |
| Last Modified By | Gail E. Collins |
| File Modified | 2011-03-07 |
| File Created | 2011-03-07 |