| 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 2009: October 1, 2008 through September 30, 2009 |
| 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 |
$ |
$ |
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Blank Cell |
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| a) Total Administrative Costs (not to exceed 10% of title IV-B, subpart 1 total allotment) |
$ |
$ |
|
|
|
|
| 6. Total title IV-B, subpart 2 funds (This amount should equal the sum of lines a - f.) |
$ |
$ |
|
|
|
|
| a) Family Preservation Services |
$ |
$ |
|
|
|
|
| b) Family Support Services |
$ |
$ |
|
|
|
|
| c) Time-Limited Family Reunification Services |
$ |
$ |
|
|
|
|
| d) Adoption Promotion and Support Services |
$ |
$ |
|
|
|
|
| e) Other Service Related Activities (e.g. planning) |
$ |
$ |
|
|
|
|
| f) Administrative Costs (FOR STATES: not to exceed 10% of total title IV-B, subpart 2 allotment after October 1, 2007) |
$ |
$ |
|
|
|
|
| 7. Total Monthly Caseworker Visit Funds (STATE ONLY) |
$ |
$ |
|
|
|
|
| a) Administrative Costs (not to exceed 10% of MCV allotment) |
$ |
$ |
|
|
|
|
| 8. Total Chafee Foster Care Independence Program (CFCIP) funds |
$ |
$ |
|
|
|
|
| a) Indicate the amount of allotment spent on room and board for eligible youth (not to exceed 30% of CFCIP allotment) |
$ |
$ |
|
|
|
|
| 9. Total Education and Training Voucher (ETV) funds |
$ |
$ |
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Blank Cell |
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| 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, 2012. |
| Signature and Title of State/Tribal Agency Official |
Date |
Signature and Title of Central Office Official |
Date |