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Home > Laws & Policies > Policy/Program Issuances > Program Instructions > PI-05-04

Attachment C

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*
Including ETV		 (e)
Title IV-E		 (f)
Title XX(SSBG)		 (g)
Title IV-A (TANF)		 (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.

Attachments

Attachment A:

Promoting Safe and Stable Families (PSSF) FY 2005 Allocations:
- States
HTML or PDF (13 KB)

- Territories
HTML or PDF (7 KB)

Child Welfare Services (CWS) FY 2005 State Allocations
HTML or PDF (6 KB)

   
Attachment B:

Final FY 2005 Child Abuse and Neglect Prevention and Treatment Act (CAPTA) Basic State Grant Allotments
HTML or PDF (9 KB)

Final FY 2005 Chafee Foster Care Independence Program (CFCIP) Allotments
HTML or PDF (11 KB)

Final FY 2005 Education and Training Vouchers Program (ETV) Allotments
HTML or PDF (9 KB)

   
Attachment B1: FY 2006 Estimated Allotments for Chafee Foster Care Independence Program (CFCIP) Allotments and Education and Training Vouchers Program (ETV) Allotments
HTML or PDF (8 KB)
   
Attachment C:

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 and Form
HTML or PDF (18 KB)

CFS-101, Part II: Annual Summary of Child and Family Services Instructions
HTML or PDF (16 KB)

CFS-101, Part II: Annual Summary of Child and Family Services Form
HTML or PDF (15 KB)

   
Attachment D: Regional Administrators
HTML or PDF (7 KB)