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Enclosure 2

INSTRUCTION FOR COMPLETING:

Quarterly Statement of Expenditures for Foster Care and Adoption Assistance under Title IV, Part E of the Social Security Act. (Form No.: IV-E-2).

1. General

   Use Form IV-E-2, which supersedes Form IV-E(or IV-A-FC)-2, to report quarterly expenditures of funds for Foster Care and Adoption Assistance under Title IV, Part E, of the Social Security Act. Submit the completed report, signed by the State Administrator of the State/jurisdiction agency or his designated representative, not later than thirty (30) days after the end of each calendar quarter to:

   Financial Management Division Children's Bureau P.0. Box 1182 Washington, D.C. 20013

   At the same time send one copy of the report to the appropriate Regional Program Director for Children, Youth and Families.

2. Detailed Instructions

   Line 1:	Enter the Employer Identification Number assigned by the Internal Revenue Service. This should be the same number as shown on the computation sheet attached to quarterly grant award.
   Line 2:	If there are attachments to this form for purposes of clarification, they should be numbered and included in the page count. In all cases, the IV-E-2 will be page 1.
   Line 3:	Self-explanatory.
   Line 4:	From: Enter the beginning date of the calendar quarter being reported upon. To: Enter the ending date of the calendar quarter being reported upon.
   Line 5:	Columns 1, 2 and 3 are used to report current quarter assistance payment data on a monthly basis, with column 1 being used for the first month of the quarter, column 2 for the second month and column 3 for the third month.

   
   
   

   Column 4 is used to report the total of columns 1, 2 and 3 and all adjustments for prior quarter assistance payments.
   Enter amounts for State and local administration expenditures in column 5.
   Enter the amounts for State and local training in column 6.
   5.a.	Enter. in columns 1, 2 and 3 the monthly number of children for whom assistance payments were made for Non-Voluntary Foster Care. Enter the total for the quarter in column 4.
   5.b.	Enter in columns 1, 2 and 3 the monthly number of children for whom assistance payments were made for Voluntary Foster Care. Enter the total for the quarter in column 4.
   5.c.	Enter in columns 1, 2 and 3 the monthly number of children for whom assistance payments were made for Adoption Assistance. Enter the total for the quarter in column 4.
   5.d.	Enter in columns 1 thru 6 the amounts of expenditures computable or subject to Federal matching that are allowable under Federal law, regulation and policy for Non-Voluntary Foster Care, without regard to the amount of the allotment limitation.
   5.e.	Enter in column 4 the appropriate Federal Medical Assistance Percentage (FMAP) under assistance payments.
   5.f.	Enter in columns 4, 5 and 6 the amounts obtained by multiplying line 5.d. times the Federal share matching rate (the FMAP) on line 5.e. of column 4.
   5.g.	Enter columns 1 thru 6 the amounts of expenditures computable or subject to Federal matching that are allowable under Federal law, regulation and policy for Voluntary Foster Care without regard to the amount of the allotment limitation.
   5.h.	Enter in columns 4, 5 and 6 the amounts obtained by multiplying the amounts on line 5.g. times the Federal share matching rate (the FMAP) on line 5.e.
   5.i.	Enter in columns 1 thru 6 the amounts of expenditures computable or subject to Federal matching that are allowable under Federal law, regulation and policy for Adoption Assistance.
   5.j.	Enter in columns 4, 5 and 6 the amounts obtained by multiplying the amounts on line 5.i. times the Federal share matching rates (the FMAP) on line 5.e.
   5.k.	In column 4, enter the total Federal share of all title IV-D Child Support collections received by the State/jurisdiction from or on account of recipients of assistance payments during this quarter.
   5.1.	In columns 4 through 6, enter the Federal share of adjustments made during this quarter as a result of a Federal audit report. Omit adjustments reported on previous quarterly statements of expenditures (unless this one is a revision). If the audit report covered more than foster care and adoption, be sure to enter only amounts applicable to foster care and adoption. Specify the HHS Audit control number in the space provided in the stub. If the amount consists of more than one adjustment, provide itemized details on an attached page.
   5.m.	In columns 4 through 6, enter the total Federal share of all decreasing adjustments during this quarter (other than those reported on line 5.1.) that are necessary to correct an amount reported in a prior period. Include also any collections received by the State/jurisdiction from or on account of recipients of assistance payments during this quarter exclusive of title IV-D Child Support Enforcement. On an attached page, provided an accounting of the adjustments reported which indicates their amounts, program, purpose and the fiscal periods to which they apply.
   5.n.	In columns 4 through 6, enter the Federal share of adjustments during this quarter increasing claims for expenditures in prior periods. On an attached page, provide an accounting of the adjustments reported on which indicates their amounts, program, purpose. and the fiscal year to which they apply.

   
   
   

   Line 6:	Self-explanatory.
   Line 7:	In the blocks provided, complete and sign the certification of the report. It should be completed and signed by the Executive Officer of the State/juris- diction agency or designated representative. Copies of the report may carry the signatory's stamped signature or initials.

   
   
   

Enclosures

Enclosure 1 - Revised Form IV-E-1 with instructions
Enclosure 3 - Comparison between old and revised Form IV-E-2