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Home > Laws & Policies > Policy/Program Issuances > Program Instructions > PI-09-06 > Attachement D: CFS-101, Part III: Expenditures for Title IV-B, Subparts 1 and 2*, Chafee Foster Care Independence (CFCIP) and Education and Training Voucher (ETV) Programs

Attachment D

U.S. Department of Health and Human Services
Administration for Children and Families		 OMB Approval #0980-0047
Approved through July 31, 2011

CFS-101, Part III: Expenditures for Title IV-B, Subparts 1 and 2*, Chafee Foster Care Independence (CFCIP) and Education and Training Voucher (ETV) Programs

Note: Federal funds for the most of the programs identified above are awarded to States or Tribes on a yearly basis, but may be spent over a two-year period ending on September 30 of the year following the year in which they were awarded. For example, the FY 2007 grant allocation has an expenditure period from October 1, 2006 to September 30, 2008. Therefore, any fiscal year 2007 funds must be obligated during that two-year period of time and subsequently reported on this form.

Most figures in the "estimate" column can be found in a State's/Tribe's previously approved CFS 101, Part I for the fiscal year being reported on.

  1. State or ITO: Enter the name of the State or Indian Tribal Organization (ITO).


  2. EIN: Indicate the Employer Identification Number (EIN).


  3. Address: Enter the address of the State or ITO Agency


  4. Submission: Indicate if this is a new or revised expenditure report.


  5. Total title IV-B, subpart 1 funds: Indicate the estimated expenditures and actual expenditures of title IV-B, subpart 1 Federal funds for the designated fiscal year for Child Welfare Services. Indicate as accurately as possible, the number of individuals and the number of families served, the population served, and the geographic area where services were provided. The required 25% match should not be reflected on this form.
    1. Specify the estimated allotment and actual expenditures of title IV-B, subpart 1 funds for administration. Note that administrative costs may not exceed 10% of the title IV-B, subpart 1 total expenditures.
  6. Total title IV-B, subpart 2 Promoting Safe and Stable Families (PSSF) funds: Indicate the estimated expenditures and actual expenditures of title IV-B, subpart 2 funds for the designated fiscal year for Promoting Safe and Stable Families services. The required 25% match should not be reflected on this form.
    1. Indicate the estimated allotment and actual expenditures of title IV-B, subpart 2 PSSF funds for the designated fiscal year for Family Preservation Services. Indicate as accurately as possible, the number of individuals and the number of families served,1 the population served,2 and the geographic area where services were provided.3 Note that these funds may be spent over a two-year period ending on September 30 of the fiscal year following the year in which they were awarded.


    2. Indicate the estimated and actual expenditures of title IV-B, subpart 2 PSSF funds allotted for the designated fiscal year for Family Support Services. Indicate as accurately as possible, the number of individuals and the number of families served, the population served, and the geographic area where services were provided. Note that these funds may be spent over a two-year period ending on September 30 of the fiscal year following the year in which they were awarded.


    3. Indicate the estimated and actual expenditures of title IV-B, subpart 2 PSSF funds allotted for the designated fiscal year for Time-Limited Family Reunification Services. Indicate as accurately as possible, the number of individuals and the number of families served, the population served, and the geographic area where services were provided. Note that these funds may be spent over a two-year period ending on September 30 of the fiscal year following the year in which they were awarded.


    4. Indicate the estimated and actual expenditures of title IV-B, subpart 2 PSSF funds allotted for the designated fiscal year for Adoption Promotion and Support Services. Indicate as accurately as possible, the number of individuals and the number of families served, the population served, and the geographic area where services were provided. Note that these funds may be spent over a two-year period ending on September 30 of the year following that in which they were awarded.


    5. Indicate the estimated and actual expenditures of title IV-B, subpart 2 PSSF funds allotted for the designated fiscal year for other service related activities (e.g. planning). Note that these funds may be spent over a two-year period ending on September 30 of the fiscal year following the year in which they were awarded.


    6. Indicate the estimated and actual expenditures of title IV-B, subpart 2 PSSF funds allotted for the designated fiscal year for administrative costs. Note that these funds may be spent over a two-year period ending on September 30 of the fiscal year following the year in which they were awarded. Beginning in FFY 2008, States' administrative costs may not exceed 10% of the total expenditures for title IV-B, subpart 2. (This limitation does not apply to Tribes.)
  7. Total title IV-B subpart 2, Monthly Caseworker Visit (MCV) Funds (States only): Indicate the estimated and actual expenditures allotted for the designated fiscal year. Note that with the exception of FY 2006 grants, these funds may be spent over a two-year period ending on September 30 of the fiscal year following the year in which they were awarded. For FY 2007, no grants were made under this program. Therefore, when completing the form for FY 2007, the amounts listed here should be $0 for estimates and expenditures.
    1. Indicate the estimated and actual expenditures of title IV-B, subpart 2 Monthly Caseworker Visit funds allotted for the designated fiscal year (States only). Note that these funds may be spent over a two-year period ending on September 30 of the fiscal year following the year in which they were awarded. Beginning in FFY 2008 total administrative costs may not exceed 10% of the total expenditures for title IV-B, subpart.
  8. Chafee Foster Care Independence Program (CFCIP) Funds: Indicate the estimated and actual expenditures of CFCIP funds allotted for the designated fiscal year for independent living activities as provided in the APSR or CFSP Program Instruction.
    1. Indicate the estimated and actual expenditures of the State's or Tribe's allotment for the designated fiscal year for room and board for eligible youth (not to exceed 30% of CFCIP funds). Note that these funds may be spent over a two-year period ending on September 30 of the fiscal year following they year in which they were awarded. Indicate as accurately as possible, the number of clients served, the population served, and the geographic area where services were provided.

  9. Total funds allotted under Section 477 for the Education and Training Vouchers (ETV) Program: Indicate the estimated and actual expenditures of Education and Training Voucher funds allotted for the designated fiscal year as provided in the annual Program Instruction on the APSR or CFSP. Indicate as accurately as possible, the number of clients served, the population served, and the geographic area where services were provided.


  10. Certification: This report must be signed and dated in the spaces provided. The signature and title must be included 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, MCV and CAPTA programs.

By signing this form the State/Tribal official certifies that all figures provided here are accurate.

* Title IV-B, subpart 2 includes both the Promoting Safe and Stable Families Program and the Monthly Caseworker Visit Program. Back
1 Report, as accurately as possible, the number of clients served per service/activity for the amount of funds expended. Indicate the number of individuals and the number of families served as labeled in the column. Back
2 Indicate the population that has received the designated services. This may include a range of vulnerable populations such as children at imminent risk of placement, all children in foster care, families with children returning home following placement, all eligible children, eligible children under 21 years, or eligible children requiring treatment, families with a child abuse or neglect investigation, children in contracted care, and/or families in crisis. Back
3 Indicate the number and type of areas identified within the State where services are to be provided for each program. Areas may include specific regions, counties, cities, reservations, communities, census tracts, or neighborhoods. Back


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Attachments

Attachment A:

Fiscal Year 2009 Allotment Title IV-B Subpart 1 Stephanie Tubbs Jones Child Welfare Services
HTML or PDF (23 KB)

Fiscal Year 2009 Allotment Title IV-B Subpart 2 Promoting Safe and Stable Families
HTML or PDF (14 KB)

Fiscal Year 2009 Allotment for CAPTA
HTML or PDF (14 KB)

Fiscal Year 2009 Allotment for Chafee Foster Care Independence Program Allotments
HTML or PDF (13 KB)

Fiscal Year 2009 Allotment for Education and Training Vouchers
HTML or PDF (12 KB)

Fiscal Year 2010 Estimated Allotment for Title IV-B, Subpart 2 Monthly Caseworker Visit Funds
HTML or PDF (17 KB)

Attachment B:

Current Variances in the Title IV-B Provisions of Law and Regulations
HTML or PDF (29 KB)

Attachment C:

Stephanie Tubbs Jones Child Welfare Services Program (title IV-B, subpart 1) Assurances
HTML or PDF (23 KB)

Promoting Safe and Stable Families (title IV-B, subpart 2) Assurances
HTML or PDF (23 KB)

State Chief Executive Officer's Assurance Statement for the Child Abuse and Neglect State Plan
HTML or PDF (38 KB)

State Chief Executive Officer's Certification for the Chafee Foster Care Independence Program
HTML or PDF (21 KB)

State Chief Executive Officer's Certifications for the Education and Training Voucher Program/Chafee Foster Care Independence Program
HTML or PDF (19 KB)

Tribal Leader's Certification for the Education and Training Voucher Program Chafee Foster Care Independence Program
HTML or PDF (20 KB)

Attachment D:

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 (14 KB)

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 Form
HTML or PDF (42 KB)

CFS-101, Part II: Annual Summary of Child and Family Services Instructions
HTML or PDF (33 KB)

CFS-101, Part II: Annual Summary of Child and Family Services Form
HTML or PDF (33 KB)

CFS-101, Part III: Annual Expenditures for Title IV-B, Subparts 1 and 2, CAPTA, Chafee Foster Care Independence (CFCIP) and Education and Training Voucher (ETV) Instructions
HTML or PDF (17 KB)

CFS-101, Part III: Annual Expenditures for Title IV-B, Subparts 1 and 2, CAPTA, Chafee Foster Care Independence (CFCIP) and Education and Training Voucher (ETV) Form
HTML or PDF (33 KB)

Attachment E:

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

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