Home > Laws & Policies > Policy/Program Issuances > Program Instructions > PI-09-07 > Attachment D: 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 2007: October 1, 2006 through September 30, 2007

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

Attachment D

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 2007: October 1, 2006 through September 30, 2007

1. State or Indian Tribal Organization (ITO):	2. EIN:	3. Address:
4. Submission: [ ] New [ ] Revision
Description of Funds	Estimated Expenditures	Actual Expenditures	Number Served		Population served	Geographic area served
			Individuals	Families
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 - f.)	$	$	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) Other Service Related Activities (e.g. planning)	$	$	Blank Cell	Blank Cell	Blank Cell	Blank Cell
f) 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 Monthly Caseworker Visit Funds (STATE ONLY)	$	$	Blank Cell	Blank Cell	Blank Cell	Blank Cell
a) Administrative Costs (not not to exceed 10% of Federal allotment)	$	$	Blank Cell	Blank Cell	Blank Cell	Blank Cell
8. 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
9) Total Education and Training Voucher (ETV) funds	$	$	Blank Cell	Blank Cell	Blank Cell	Blank Cell
10. 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

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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-E Subpart 2 - Promoting Safe and Stable Families
HTML or PDF (14 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 (47 KB)

Promoting Safe and Stable Families (title IV-B, subpart 2) Assurances
HTML or PDF (47 KB)

Certifications for the Chafee Foster Care Independence Program
HTML or PDF (47 KB)

Tribal Leader's Certification for the Education and Training Voucher Program/Chafee Foster Care Independence Program
HTML or PDF (47 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 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)

Attachment F:

Information for Tribes on Title IV-E Training Plans
HTML or PDF (16 KB)

Attachment G:

Certification of Tribal Population Under Age 21
HTML or PDF (16 KB)

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