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Attachment F

CFS-101, Part II: Annual Summary of Child and Family Services Form

OMB Approval # 0980-0047
Approved Through July 31, 2005

State or IT ___________________________________________ For FFY October, ____ to September 30, ____

blank cell	blank cell		blank cell	blank cell	blank cell	blank cell	blank cell	blank cell	blank cell	blank cell	(k) Number to be served [ ] Families [ ] Individuals	(l) Pop. to be Served	(m) Geog. Area to be Served
Services/Activities	Title IV-B		(c) CAPTA*	(d) CFCIP*	(e) Title IV-E	(f) Title XX(SSBG)	(g) Title IV-A	(h) Title XIX (Medicaid)	(i) Other Fed Prog	(j) State Local Donated Funds	blank cell	blank cell	blank cell
	(a) I-CWS	(b) II-PSSF
1) Prevention & Support Services     (Family Support)	blank cell	blank cell	blank cell	shaded cell	shaded cell	blank cell	blank cell	blank cell	blank cell	blank cell	blank cell	Reports of abuse/neglect	Statewide/ Reservation
2) Protective Services	blank cell	shaded cell	blank cell	shaded cell	shaded cell	blank cell	blank cell	blank cell	blank cell	blank cell	blank cell	blank cell	blank cell
3) Crisis Intervention (Family     Preservation)	blank cell	blank cell	blank cell	shaded cell	shaded cell	blank cell	blank cell	blank cell	blank cell	blank cell	blank cell	blank cell	blank cell
(A) Preplacement Prevention	blank cell	blank cell	blank cell	shaded cell	shaded cell	blank cell	blank cell	blank cell	blank cell	blank cell	blank cell	All children in foster care	Statewide/ Reservation
(B) Reunification Services	blank cell	blank cell	blank cell	shaded cell	shaded cell	blank cell	blank cell	blank cell	blank cell	blank cell	blank cell	blank cell	blank cell
4) Time-Limited Family     Reunification Services	blank cell	blank cell	blank cell	shaded cell	shaded cell	blank cell	blank cell	blank cell	blank cell	blank cell	blank cell	blank cell	blank cell
5.) Adoption Promotion and     Support Services	blank cell	blank cell	shaded cell	shaded cell	shaded cell	blank cell	blank cell	blank cell	blank cell	blank cell	blank cell	All eligible children	Statewide/ Reservation
6.) Foster Care Maintenance:     (A) Foster Family & Relative          Foster Care	blank cell	shaded cell	shaded cell	shaded cell	blank cell	shaded cell	blank cell	blank cell	blank cell	blank cell	blank cell	blank cell	blank cell
(B) Group/Inst Care	blank cell	shaded cell	shaded cell	shaded cell	blank cell	shaded cell	blank cell	blank cell	blank cell	blank cell	blank cell	blank cell	Statewide/ Reservation
7) Adoption Subsidy Pmts.	blank cell	shaded cell	shaded cell	shaded cell	blank cell	shaded cell	shaded cell	shaded cell	shaded cell	blank cell	blank cell	blank cell	blank cell
8) Independent Living Services	blank cell	blank cell	shaded cell	blank cell	blank cell	shaded cell	shaded cell	shaded cell	shaded cell	blank cell	shaded cell	shaded cell	shaded cell
9) Admin & Mgmt	blank cell	blank cell	shaded cell	shaded cell	blank cell	shaded cell	shaded cell	shaded cell	shaded cell	blank cell	shaded cell	shaded cell	shaded cell
10) Staff Training	blank cell	blank cell	blank cell	blank cell	blank cell	blank cell	shaded cell	shaded cell	blank cell	blank cell	shaded cell	shaded cell	shaded cell
11) Training Parent Recruitment     & Training	blank cell	shaded cell	blank cell	shaded cell	blank cell	blank cell	shaded cell	shaded cell	blank cell	blank cell	shaded cell	shaded cell	shaded cell
12) Adoptive Parent Recruitment     & Training	blank cell	shaded cell	blank cell	shaded cell	blank cell	blank cell	shaded cell	shaded cell	blank cell	blank cell	shaded cell	shaded cell	shaded cell
13) Child Care Related to     Employment/Training	blank cell	shaded cell	shaded cell	shaded cell	blank cell	shaded cell	shaded cell	shaded cell	blank cell	blank cell	blank cell	blank cell	blank cell
14) Total	blank cell	blank cell	blank cell	blank cell	blank cell	blank cell	blank cell	blank cell	blank cell	blank cell	shaded cell	shaded cell	shaded cell

* States only, Indian Tribes are not required to include information on these programs.

ACYF-CB-PI-04-02     HTML or PDF (328 KB)
Attachment A:	Promoting Safe and Stable Families (PSFF) Tribal FY 2004 Allocations HTML or PDF (9 KB) Title IV-B, Subpart 1 - Child Welfare Services Tribal Child Population and Federal Share of Funds Fiscal Year (FY) 2004 Allotments HTML or PDF (28 KB)
Attachment B:	Current Variances in Title IV-B Provisions of Law and Regulation HTML or PDF (93 KB)
Attachment C:	CFSP/APSR Program Instruction (PI) Grid HTML or PDF (81 KB)
Attachment D:	Preparing for the FY 2005-2009 Tribal Child and Family Services Plan HTML or PDF (14 KB)
Attachment E:	Title IV-B Child And Family Services Plan: Assurances HTML or PDF (14 KB)
Attachment F:	CFS-101, Part I: Annual Budget Request for Title IV-B, Subparts 1 and 2, CAPTA, Chafee Foster Care Independence (CFCIP) and Education and Training Voucher (ETV) Program Instructions HTML or PDF (15 KB) CFS-101, Part II: Annual Summary of Child and Family Services Instructions HTML or PDF (17 KB) CFS-101, Part II: Annual Summary of Child and Family Services Form HTML or PDF (23 KB)
Attachment G:	Regional Administrators HTML or PDF (67 KB)