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

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Attachment C

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

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

State or IT ___________________________________________ For FFY October 2, ____ to September 30, ____ Due June 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(TANF)		 (h)
Title XIX
(Medicaid)		 (i)
Other Fed Prog		 (j)
State Local Donated Funds		 blank cell blank cell blank cell
blank cell (a)
I-CWS		 (b)
II-PSSF		 blank cell blank cell blank cell blank cell blank cell blank cell blank cell blank cell blank cell blank cell blank cell
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 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 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) Foster 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

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

Attachments

ACYF-CB-PI-05-05    HTML or PDF (29 KB)
Attachment A 1 - FY 2005 estimated Title IV-B, subpart 1 allotments
   HTML or PDF (32 KB)
Attachment A 2 - FY 2005 estimated Title IV-B, subpart 2 allotments
   HTML or PDF (10 KB)
Attachment B - Certification of Tribal Population Under Age 21
   HTML or PDF (8 KB)
Attachment C 1 - CFS-101, Part I, Annual Budget for Title IV-B, subparts 1 & 2
   HTML or PDF (16 KB)
Attachment C 2 - CFS-101, Part II, Annual Summary of Child and Family Services
   HTML or PDF (15 KB)
Attachment C 3 - CFS-101, Part II, Annual Summary of Child and Family Services Instructions (new applicants only)
   HTML or PDF (31 KB)
Attachment D - ACF Regional Administrators
   HTML or PDF (8 KB)

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