NonDiscretionary Financial Form GenIC - Form CB-496

Request for Approval under the “Generic Clearance for Financial Reports ACF Non-Discretionary Grant Programs”

OMB Control Number: 0970-0510

TITLE OF INFORMATION COLLECTION: Form CB-496 - Title IV-E Programs Quarterly Financial Report

PURPOSE AND USE: Form CB-496, the Title IV-E Programs Quarterly Financial Report, is used by title IV-E agencies to submit financial claims for the title IV-E entitlement grant programs. The information collected through the use of this form is used to:

• Monitor title IV-E Foster Care, Adoption Assistance, Guardianship Assistance, Kinship Navigator and Prevention Services program operations and prepare technical assistance and guidance as needed;

• Compute the quarterly grant awards pursuant to sections 474(b)(1-3) and 474(a)(5-7) of the Social Security Act;

• Account for the calculation and expenditure of adoption savings achieved through the use of revised title IV-E Adoption Assistance eligibility criteria with respect to applicable children (annual report only).

This form was originally approved in 2018 and has been updated and approval extended since that time. We are now (September 2024) seeking changes to the form and instructions based on the need to remove reporting items no longer needed, and the addition or revision of reporting lines and instructions required due to recent changes in program regulations, policy guidance, and other operational changes for which further information will enhance the administration of the program. A summary of the requested changes to the CB-496 form and reporting instructions is included in the accompanying Change Memo (Dated September 2024).

DESCRIPTION OF RESPONDENTS: State and tribal governmental agencies administering title IV-E programs.

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ ] Yes [X] No

2. If Yes, will any information that is collected be included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No

3. If Yes, has an up-to-date System of Records Notice (SORN) been published? [ ] Yes [ ] No

BURDEN HOURS

Title of Information Collection	No. of Respondents	Annual Frequency of Responses	Hourly Burden per Response	Annual Hourly Burden
Form CB-496	67	4	23	6154

FEDERAL COST: The estimated annual cost to the Federal government is $194,180. The cost to the Federal Government includes the contracting for operation and maintenance (O&M) of the OLDC system to support automated submission of this form and of staff salaries to conduct review and analysis of submitted forms. ACF estimates an annual OLDC O&M of approximately $75,000 and that approximately 2,680 hours are required for the analysis and review of the form. At an estimated hourly salary cost of $44.47, the Federal staff cost to the government is $119,180. Estimated total cost to the Federal Government is thus $194,180.

PUBLIC COMMENT: ACF published a notice in the Federal Register announcing the agency’s intention to request OMB’s review of changes to this generic information collection activity.

__89_ FR _689027___ Date: _August 28, 2024__

This notice provided a 14-day period for public comment. We received one set of comments on the proposed collection of information. Comments are included as Attachment I. An overview of the comments and ACF’s responses follow.

The one set of comments received are supportive of the proposed CB-496 form changes. A concern was raised that the commenting title IV-E agency will need two years or longer to update its automated system to breakout reporting data in the manner now prescribed on form CB-496 and thus seeks an extension of the one-year period (thru FFY 2025) in which the cited reporting change is optional. ACF has determined not to extend the optional reporting period beyond one-year but recognizes that some title IV-E agencies may need additional assistance. We, therefore, added a sentence to the reporting instructions as follows:

Upon request, ACF will provide technical assistance to title IV-E agencies to facilitate this reporting, as needed.

Attachments

• CB-496 Form (updated September 2024)

• CB-496 Instructions (updated September 2024)

• Change Memo – CB-496 September 2024 Updates

• Comments Received – Attachment I

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