CFS-101, Parts I, II, and III

CFS-101, PART I Attachment B

U.S. Department of Health and Human Services OMB Approval #0980-0047

Administration for Children and Families Approved through July 31, 2011

CFS-101, Part I: Annual Budget Request for Title IV-B, Subpart 1 & 2 Funds, CAPTA, CFCIP, and ETV 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.

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.

3. Submission: Indicate if this is a NEW submission for the upcoming Fiscal Year, or a REVISION of the budget request for the current year.

5. Total 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 during the fiscal year on the Stephanie Tubbs Jones Child Welfare Services (CWS) Program. The previous Federal Fiscal Year’s (FFY) final allotment as provided in the annual Program Instruction on the Annual Progress and Services Report (APSR) or CFSP is to be used as the estimated amount for the State’s/Tribe’s request. ¹ A 25% match is required and the State or Tribe’s match amount should be reflected on the SF-425 report.

a) Specify the estimated amount of title IV-B, subpart 1 CWS funds entered on line 5 to be spent on administration (not to exceed 10% of the total title IV-B, subpart 1 estimated allotment).

6. Total 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 during the fiscal year on the Promoting Safe and Stable Families (PSSF) Program. The previous Federal Fiscal Year’s (FFY) final allotment as provided in the annual Program Instruction on the APSR or CFSP 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 should be reflected on the SF-425 report. Tribes are not required to complete items 6 a-f.

a) Specify the estimated amount of title IV-B, subpart 2 PSSF funds to be spent during the fiscal year for Family Preservation Services (a strong rationale must be provided in the APSR or CFSP if amount is less than 20% of line 6).

b) Specify the estimated amount of title IV-B, subpart 2 PSSF funds to be spent during the fiscal year for Family Support Services (a strong rationale must be provided in the APSR or CFSP if amount is less than 20% of line 6).

c) Specify the estimated amount of title IV-B, subpart 2 PSSF funds to be spent during the fiscal year for Time-Limited Family Reunification Services (a strong rationale must be provided in the APSR or CFSP if amount is less than 20% of line 6).

d) Specify the estimated amount of title IV-B, subpart 2 PSSF funds to be spent during the fiscal year for Adoption Promotion and Support Services (a strong rationale must be provided in the APSR or CFSP if amount is less than 20% of line 6).

e) Specify the estimated amount of title IV-B, subpart 2 PSSF funds to be spent during the fiscal year for other service related activities (e.g. planning).

f) Specify the estimated amount of title IV-B, subpart 2 PSSF funds to be spent on administration. (For STATES only, not to exceed 10% of the total title IV-B, subpart 2 estimated allotment.)

7. Monthly Caseworker Visit title IV-B, subpart 2 funds (for STATES only): Specify the estimated amount of title IV-B, subpart 2 Monthly Caseworker Visitation (MCV) Federal Funds the State expects to spend during the fiscal year.

a) Specify the estimated amount of title IV-B, subpart 2 MCV funds entered on line 7a to be spent on administration (not to exceed 10% of the total title IV-B, subpart 2 MCV estimated allotment).

8. Re-allotment of Title IV-B, subparts 1 & 2 funds for State and ITO: The Administration for Children and Families (ACF) is able to re-allot unneeded portions of State and Tribal allocations of title IV-B, subparts 1& 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.

1. Indicate the amount of Federal funds of CWS, PSSF and/or MCV ( for States only) that the State or Tribe does not expect to utilize.

b) Indicate the amount of Federal funds of CWS, PSSF and/or MCV (for States only) that the State or Tribe is requesting, if additional funds become available.

9. Child Abuse Prevention and Treatment Act (CAPTA) (for STATES only): Indicate the State’s estimated CAPTA State Grant allocation as provided in the annual Program Instruction on the APSR. Supplemental funds may be available for distribution if there are States that are not awarded grant funds or there are unobligated funds available for redistribution. No matching funds are required for this grant.

10. Estimated Title IV-E Chafee Foster Care Independence Program (CFCIP) Funds: Indicate the estimated amount of CFCIP funds that the State or Tribe expects to spend on independent living activities as provided in the APSR or CFSP Program Instruction.

a) At State or Tribe option, indicate the estimated amount of the funds entered on line 10 a to be spent for room and board for eligible youth (not to exceed 30% of total estimated CFCIP allotment.)

11. Estimated Title IV-E Funds Allotted under Section 477 for the Education and Training Vouchers (ETV) Program: Indicate the estimated amount of ETV funds that the State or Tribe expects to spend on ETV as provided in the APSR or CFSR Program Instruction.

12. Re-allotment of CFCIP and/or ETV Funds for States or Tribes: The Administration for Children and Families (ACF) is able to re-allot unneeded portions of State or Tribe allocations of CFCIP and ETV funds to other States or Tribes so that the total appropriation remains available for program purposes. In order for a State or Tribe to be awarded portions of these funds, or for funds to be released, ACF must have on file a request from the State or Tribe for additional funds, or the release of funds.

a) Indicate the amount of funds that the State or Tribe will not utilize from its allotment to carry out the CFCIP activities.

b) Indicate the amount of funds that the State or Tribe will not utilize from its allotment to carry out the ETV program activities.

c) Indicate the amount of funds the State or Tribe is requesting if additional funds become available for the CFCIP program. A 20% State or Tribe match is required. The State or Tribe match amount must be reflected on the SF-425 report.

d) Indicate the amount of funds the State or Tribe is requesting if additional funds become available for the ETV program. A 20% State or Tribe match is required. The State or tribe match amount must be reflected on the SF-425 report.

13. 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.

By signing this form the State/Tribal official assures that the State/Tribe will meet all applicable match requirements.

1 The tentative allotments for title IV-B, subpart 1 and 2, CFCIP, and ETV 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 Children’s Bureau in the State’s/Tribe’s APSR or CFSP.

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.

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