Attachment C
| U.S. Department of Health and Human Services Administration for Children and Families |
OMB Approval #0980-0047 Approved through October 31, 2008 |
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
Note: While the information on the programs are consolidated into one Child and Family Services Plan (CFSP), eligibility and expenditure reports for the individual programs are separate. Funding will not be delayed for one program due to potential eligibility issues in another program.
Complete separate forms for each fiscal year.
- Enter the name of the State or Indian Tribal Organization (ITO).
- Indicate the Employer Identification Number (EIN).
- Enter the address of the State or ITO Agency.
- Indicate if this is a new or revised budget request.
- Estimated title IV-B, subpart 1 funds:
Specify the estimated amount of title IV-B, subpart 1 Federal funds that the State or ITO expects to spend for the designated fiscal year for Child Welfare Services. The previous Federal Fiscal Year's (FFY) final allotment as provided in the annual Program Instruction on the Annual Progress and Services Report (APSR) is to be used as the estimated amount for the State's/Tribe's request. A 25% match is required and the State or Tribe's match amount must be reflected on the final SF-269 report. - Estimated title IV-B, subpart 2 funds:
Specify the total estimated amount of title IV-B, subpart 2 Federal funds that the State or ITO expects to spend for the designated fiscal year for Promoting Safe and Stable Families services. The previous Federal Fiscal Year's (FFY) final allotment as provided in the annual Program Instruction on the APSR is to be used as the estimated amount for the State's/Tribe's request. A 25% match is required and the State or Tribe's match amount must be reflected on the final SF-269 report.
a) Specify the estimated amount of title IV-B, subpart 2 funds to be spent for the designated fiscal year for Family Preservation Services.
b) Specify the estimated amount of title IV-B, subpart 2 funds to be spent for the designated fiscal year for Family Support Services.
c) Specify the estimated amount of title IV-B, subpart 2 funds to be spent for the designated fiscal year for Time-Limited Family Reunification Services.
d) Specify the estimated amount of title IV-B, subpart 2 funds to be spent for the designated fiscal year for Adoption Promotion and Support Services.
e)Specify the estimated amount of title IV-B, subpart 2 funds to be spent for the designated fiscal year for other service related activities (e.g. planning).
f) Specify the estimated amount of title IV-B, subpart 2 funds to be spent for the designated fiscal year for Administration (not to exceed 10% of a State's estimated allotment).
g) Specify the estimated amount of title IV-B, subpart 2 funds to be spent for the designated fiscal year for caseworker visits (States only). - Re-allotment of title IV-B, Subpart 2 funds for State and Indian Tribal Organizations
The Administration for Children and Families (ACF) is able to re-allot unneeded portions of State and Tribal allocations of title IV-B, subpart 2 funds to other States and eligible Indian Tribes so that the total appropriation remains available for program purposes. In order for a State or ITO to be awarded a portion of these funds, or for funds to be released, ACF must have on file a request from the State or Indian Tribe for additional funds, or the release of funds.
a) Indicate the amount of Federal funds that the State or Tribe does not expect to utilize for the upcoming fiscal year;
b) Indicate the amount of Federal funds that the State or Tribe is requesting if additional funds become available. - Child Abuse Prevention and Treatment Act (CAPTA) (States only).
Indicate the State's estimated CAPTA State Grant allocation as provided in the annual Program Instruction on the APSR. No matching funds are required for this grant.
- Estimated Chafee Foster Care Independence Program (CFCIP) Funds (States only)
Indicate the estimated amount of CFCIP funds that the State expects to spend during the fiscal year on independent living activities as described in the annual Program Instruction on the APSR. - Estimated Funds Allotted under Section 477 for the Education and Training Vouchers (ETV) Program (States only)
Indicate the estimated amount of ETV funds that the State expects to spend during the fiscal year on education and training vouchers as described in the annual Program Instruction on the APSR. - Re-allotment of CFCIP and/or ETV program funds for States
The Administration for Children and Families (ACF) is able to re-allot unneeded portions of State allocations of CFCIP and ETV funds to other States so that the total appropriation remains available for program purposes. In order for a State to be awarded portions of these funds, or for funds to be released, ACF must have on file a request from the State for additional funds, or the release of funds.
a) Indicate the amount of funds that the State does not expect to utilize from its allotment during the upcoming fiscal year to carry out the CFCIP activities.
b) Indicate the amount of funds that the State does not expect to utilize from its allotment during the upcoming fiscal year to carry out the ETV program activities.
c) Indicate the amount of funds the State is requesting if additional funds become available for the CFCIP and/or ETV programs. A 20% State match is required. The State match amount must be reflected on the final SF-269 report. - Certification: This report must be signed and dated in the spaces provided. The signature and title of the official of the State agency, or Indian Tribal Organization, with authority to administer or supervise the administration of title IV-B, subparts 1 and 2 programs and, for States only, the CAPTA and CFCIP programs, must be included.
The tentative allocations are based on the premise that all States and Indian Tribes will apply for and receive the funds available to them. In the event that not all States or Indian Tribes apply for or receive their tentative allocations, those funds will be redistributed among eligible States and Indian Tribes, where permitted by statute. States requesting additional funds in anticipation of such a redistribution should submit information on the proposed use of such additional funds to the appropriate Regional Office of the Administration for Children and Families in the State's/Tribe's APSR.
When States or Tribes that have not applied for funds available to them in past fiscal year(s) decide to do so, depending upon the total amount of funds appropriated by Congress for the next fiscal year, there may be a reduction in the final distribution of funds.
By signing this form the State/Tribal official assures that the State/Tribe will meet all applicable match requirements.
CFS-101, Part I: Annual Budget Request For Title IV-B, Subpart 1 & 2 Funds, CAPTA, Chafee Foster Care Independence Program (CFCIP) and Education and Training Vouchers (ETV):
Fiscal Year 20__, October 1, 20__ through September 30, 20__1. State or ITO: |
2. EIN: |
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3. Address: |
4. Submission: [ ] New [ ] Revision |
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5. Total estimated Federal title IV-B, Subpart 1 Funds. |
$ |
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6. Total Estimated Federal title IV-B, Subpart 2 Funds. (This amount should equal the sum of lines a-f.) |
$ |
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a) Total Family Preservation Services. |
$ |
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b) Total Family Support Services. |
$ |
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c) Total Time-Limited Family Reunification Services. |
$ |
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d) Total Adoption Promotion and Support Services. |
$ |
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e) Total for Other Service Related Activities (e.g. planning). |
$ |
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f) Total Administration (not to exceed 10% of estimated allotment). |
$ |
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g) Caseworker visits |
$ |
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7. Re-allotment of Title IV-B, Subpart 2 funds for State and Indian Tribal Organizations a) Indicate the amount of the State’s/Tribe’s allotment that will not be required to carry out the Promoting Safe and Stable Families program. $______________ b) If additional funds become available to States and ITOs, specify the amount of additional funds the State or Tribes is requesting. $_________________ |
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8. Child Abuse Prevention and Treatment Act (CAPTA) State Grant (no State match required) Estimated Amount $ , plus additional allocation, as available. |
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9. Estimated Chafee Foster Care Independence Program (CFCIP) funds. |
$ |
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10. Estimated Education and Training Voucher (ETV) funds. |
$ |
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11. Re-allotment of CFCIP and ETV Program Funds: a) Indicate the amount of the State’s allotment that will not be required to carry out CFCIP $___________. b) Indicate the amount of the State’s allotment that will not be required to carry out ETV $___________. c) If additional funds become available to States, specify the amount of additional funds the State is requesting for CFCIP $___________________ for ETV program $_________________________. |
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12. Certification by State Agency and/or Indian Tribal Organization. The State agency or Indian Tribe submits the above estimates and request for funds under title IV-B, subpart 1 and/or 2, of the Social Security Act, CAPTA State Grant, CFCIP and ETV programs, and agrees that expenditures will be made in accordance with the Child and Family Services Plan, which has been jointly developed with, and approved by, the ACF Regional Office, for the Fiscal Year ending September 30, 20__. |
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Signature and Title of State/Tribal Agency Official |
Signature and Title of Regional Office Official |
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Attachments
PI 07-05: HTML or PDF (221 KB)
| Attachment A: FY 2007 Allocations: |
1) Title IV-B, Subpart 1, Child Welfare Services (CWS) 2) Title IV-B, Subpart 2, Promoting Safe and Stable Families (PSSF) a) 2006 State allocation for Caseworker Visits 3) Child Abuse and Neglect Prevention and Treatment Act (CAPTA) 4) Chafee Foster Care Independence Program (CFCIP) 5) Education and Training Vouchers (ETV) |
| Attachment B: FY 2008 Estimated Allotments |
Chafee Foster Care Independence Program (CFCIP) |
| 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 Vouchers (ETV) Program Instructions Part II: Annual Summary of Child and Family Services Instructions Part II: Annual Summary of Child and Family Services Form Part III: Annual Expenditures Title IV-B, Subparts 1 and 2, CFCIP, and ETV Program: |
| Attachment D: | |
| Attachment E: |
Children's Bureau Regional Program Managers |
