ACYF-CB-PI-08-04: Attachment B: CFS-101, Part III: Annual Expenditures for Title IV-B, Subparts 1 and 2, Chafee Foster Care Independence (CFCIP) and Education And Training Voucher (ETV): Fiscal Year 2006: October 1, 2005 through September 30, 2006

U.S. Department of Health and Human Services
Administration for Children and Families

Attachment B

CFS-101, PART III: Annual Expenditures for Title IV-B, Subparts 1 and 2, Chafee Foster Care Independence (CFCIP) and Education And Training Voucher (ETV) : Fiscal Year 2006: October 1, 2005 through September 30, 2006

1. State or ITO:	2. EIN:	3. Address:
4. Submission: [ ] New [ ] Revision		3. Address:
*Description of Funds*	*Estimated Expenditures*	*Actual Expenditures*	*Number Served*		*Population served*	*Geographic area served*
*Description of Funds*	*Estimated Expenditures*	*Actual Expenditures*	Individuals	Families	*Population served*	*Geographic area served*
5. Total title IV-B, subpart 1 funds	$	$	Blank Cell	Blank Cell	Blank Cell	Blank Cell
a) Total Administrative Costs (not to exceed 10% of Federal allotment)	$	$	Blank Cell	Blank Cell	Blank Cell	Blank Cell
6. Total title IV-B, subpart 2 funds (This amount should equal the sum of lines a - g).	$	$	Blank Cell	Blank Cell	Blank Cell	Blank Cell
a) Family Preservation Services	$	$	Blank Cell	Blank Cell	Blank Cell	Blank Cell
b) Family Support Services	$	$	Blank Cell	Blank Cell	Blank Cell	Blank Cell
c) Time-Limited Family Reunification Services	$	$	Blank Cell	Blank Cell	Blank Cell	Blank Cell
d) Adoption Promotion and Support Services	$	$	Blank Cell	Blank Cell	Blank Cell	Blank Cell
e) Total for Other Service Related Activities (e.g. planning)	$	$	Blank Cell	Blank Cell	Blank Cell	Blank Cell
f) Monthly Caseworker Visits (FOR STATES)	$	$	Blank Cell	Blank Cell	Blank Cell	Blank Cell
g) Total Administrative Costs (FOR STATES: not to exceed 10% of total allotment after October 1, 2007)	$	$	Blank Cell	Blank Cell	Blank Cell	Blank Cell
7. Total Chafee Foster Care Independence Program (CFCIP) funds	$	$	Blank Cell	Blank Cell	Blank Cell	Blank Cell
a) Indicate the amount of State's allotment spent on room and board for eligible youth (not to exceed 30% of CFCIP allotment)	$	$	Blank Cell	Blank Cell	Blank Cell	Blank Cell
8. Total Education and Training Voucher (ETV) funds	$	$	Blank Cell	Blank Cell	Blank Cell	Blank Cell
9. Certification by State Agency or Indian Tribal Organization (ITO). The State agency or ITO agrees that expenditures were made in accordance with the Child and Family Services Plan, which has been jointly developed with, and approved by, the Children's Bureau, for the Fiscal Year ending September 30, 20__.
*Signature and Title of State/Tribal Agency Official*	*Date*	*Signature and Title of Central Office Official*				*Date*

Attachments

PI 08-04
HTML or PDF (77 KB)

Attachment A: FY 2008 Tribal Allocation Tables

Title IV-B, subpart 1, Child Welfare Services
HTML or PDF (55 KB)
Title IV-B, subpart 2, Promoting Safe and Stable Families
HTML or PDF (63 KB)

Attachment B: CFS-101

Part I: Annual Budget Request for Title IV-B, Subparts 1 & 2 Funds, CAPTA, CFCIP, and ETV Instructions
HTML or PDF (24 KB)
Part I: Annual Budget Request for Title IV-B, Subparts 1 & 2 Funds, CAPTA, CFCIP, and ETV Form
HTML or PDF (18 KB)
Part II: Annual Summary of Child and Family Services Instructions
HTML or PDF (41 KB)
Part II: Annual Summary of Child and Family Services Form
HTML or PDF (31 KB)
PART III: Annual Expenditures for Title IV-B, Subparts 1 and 2, Chafee Foster Care Independence (CFCIP) and Education And Training Voucher (ETV) Instructions
HTML or PDF (28 KB)
PART III: Annual Expenditures for Title IV-B, Subparts 1 and 2, Chafee Foster Care Independence (CFCIP) and Education And Training Voucher (ETV) Form
HTML or PDF (24 KB)

Attachment C: Children's Bureau Regional Program Managers
HTML or PDF (16 KB)