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Attachment III

OMB Approval 0980-0047
Approved thru 9/30/86

ANNUAL SUMMARY OF CHILD WELFARE SERVICES

State of           for Fiscal Year October 1, 19     to September 30, 19   

SERVICES/ACTIVITIES	ESTIMATED EXPENDITURES BY PROGRAM ($ THOUSANDS)				ESTIMATED NUMBER OF CLIENTS TO BE SERVED
	FEDERAL FUNDS			STATE/LOCAL & DONATED
	IV-B	IV-E/IV-A	OTHER*
1) Preventive/Supportive Services, including Protective Services
2) Foster Care Maintenance Payments a) Foster Family Care b) Group/Institutional Care
3) Foster Care Services
4) Adoption Subsidy Medical Services for Adoption Assistance Other Adoption Services (Specify)
5) Administration and Management
6) Day Care Related to Employment or Training for Employment

OTHER FEDERAL PROGRAMS

Attachments:

Attachment I - Certification of Eligibility for Additional Funds Under Section 427 of the Social Security Act
Attachment II - Annual Budget Request for Title IV-9 Funds
Attachment IV - Instructions for the Preparation of the Annual Summary of Child Welfare Services