CFS-101, Parts I, II, and III

CFS-101 Instructions

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

Attachment B OMB Approval #0970-0426

Approved through XXXX

PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to collect data for the CFS-101 financial form. Public reporting burden for this collection of information is estimated to average 5 hours per grantee, including the time for reviewing instructions, gathering, and maintaining the data needed, and reviewing the collection of information. This is a mandatory collection of information (Section 432(a)(8)(B) of the Social Security Act. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0426 and the expiration date is XX/XX/XXXX. If you have any comments on this collection of information, please contact Jan Rothstein at jan.rothstein@acf.hhs.gov.

Instructions for Completing the CFS-101 Forms

Introduction

The CFS-101 is a set of financial forms required by State Agencies, Territories, Insular Areas (States), Indian Tribes, Indian Tribal Organizations, or Indian Tribal Consortia (Tribes) to apply for and receive funding under title IV-B, subparts 1 and 2 of the Social Security Act, the Child Abuse Prevention and Treatment Act (CAPTA) State Grant, and the John H. Chafee Foster Care Program for Successful Transition to Adulthood (Chafee) and Education and Training Voucher (ETV) Program.

The set of CFS-101 forms has three parts:

• Part I: Annual Budget Request for Title IV-B, Subpart 1 & 2 Funds, CAPTA State Grant, Chafee, and ETV;

• Part II: Annual Estimated Expenditure Summary of Child and Family Services Funds; and,

• Part III: Annual Expenditures for Title IV-B, Subparts 1 and 2, Chafee, and ETV.

Periodically, the Children’s Bureau makes updates to the forms and instructions so it is important for grantees to use the version provided with the most recent Program Instruction for the Child and Family Services Plan (CFSP) or Annual Progress and Services Report (APSR).

When completing the CFS-101 reports, it is important to recognize that Part I and Part II are connected. On Part I, the funding requests are made for each program; Part II provides more detail on how those funds and other funds are planned to be spent for child protective and child welfare services. Finally, Part III reports grant expenditures for the most recently ended grant award year.

Data Entry Notes:

• If formulas are entered or used to distribute funds for any grant, please show only the final values in the worksheets, not the formulas.

• Break all links/references to other agency fiscal worksheets or workbooks.

• Do not round to the $ thousands or $ millions on any of the forms.

When finished, save and name the PDF file (and Excel workbook for states) as “State/Tribe name FY [year] CFS-101s” so that the name of the state or tribe submitting the file is clearly identified.

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.

CFS-101, Part I Instructions: Annual Budget Request for Funds under Title IV-B, Subparts 1 & 2, CAPTA State Grant, Chafee, and ETV

The numbering corresponds to the item numbers on the CFS-101 forms.

1. Name of State or Indian Tribal Organization and Department/Division: Enter the name of the State or Indian Tribal Organization (Tribe) and agency (Department or Division) in cell A4 of the Excel worksheet.

2. Address: Enter the mailing address of the state or tribal agency in the cells below the “address” line. This should be the address to which the grant award notices may be sent.

a) Enter the email address to which grant award notices may be sent.

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

2. DUNS: Enter the Dun and Bradstreet Number (DUNS) assigned to your organization. Information on how to obtain a DUNS is available on the grants.gov website.  A DUNS number is required to register with the U.S. Federal government for contracts or grants.

3. Submission Type: Indicate the applicable submission type.

• NEW submission for the upcoming fiscal year. A submission is “NEW” until signed by the Children’s Bureau Central Office Official; or

• Request for REALLOTMENT for current year.

Requests for Funding Section:

The annual budget request demonstrates a grantee's application for funding under each program and provides estimates on the planned use of funds. Final allotments will be determined by formula. Use the prior year allotments for these estimates.

Enter all funding requests as whole dollars, without formulas or links to other worksheets.

3. Total title IV-B, subpart 1 (CWS) funds: Enter the amount of title IV-B, subpart 1 federal funds that the state or tribe requests for the Stephanie Tubbs Jones Child Welfare Services (CWS) Program. A 25 percent match is required, which must be reflected on the SF-425 report.

a) Enter the estimated amount of title IV-B, subpart 1 CWS funds to be spent on administration. This cannot exceed 10 percent of the total title IV-B, subpart 1 allotment request entered on line 6. A warning will display if the amount entered is greater than 10 percent of the requested amount. The amount reported in 6a is a subset of line 6.

7. Total title IV-B, subpart 2 (PSSF) funds: For TRIBES only: Enter the total amount of funds for title IV-B, subpart 2 that the tribe requests for the MaryLee Allen Promoting Safe and Stable Families (PSSF) Program. (States do not complete line 7.) If any funds will be spent on administration, enter that amount in 7f.

Tribes are not required to provide the breakout for the use of funds on Part I, but may opt to complete lines 7a-f to identify planned expenditures by service category. Tribes should select the option of completing either line 7 (and 7f, if applicable), or lines 7a-f, which will then prompt the total to display on line 7g. Note that the ‘total’ lines, line 7 and 7g are not connected in any way.

7a-f. Breakout of title IV-B, subpart 2 (PSSF) funds: States must complete lines 7a–f. Line 7g sums the amounts in lines 7a-f to become the state’s total request for PSSF. Enter the amount of PSSF funds that will be expended in each category. The percentage of funds for each service category will automatically calculate. If less than 20 percent of the total (line 7g) is expected to be spent in any of the four service areas (7a – d), a strong rationale must be provided in the CFSP/ APSR narrative. A 25 percent match is required, which must be reflected on the SF-425 report.

Enter the estimated amount of PSSF funds to be spent in the following categories:

a) Family Preservation Services;

b) Family Support Services;

c) Family Reunification Services;

d) Adoption Promotion and Support Services;

e) Other Service Related Activities (e.g., planning); and

f) Administration. States are limited to a maximum of 10 percent of their PSSF request for administrative costs. A warning will display if the amount entered is greater than 10 percent of the requested amount. Tribes can disregard this warning, as there is no maximum allowable percentage of administrative funds.

8. Monthly Caseworker Visit title IV-B, subpart 2 funds (applies to STATES only): Enter the amount of title IV-B, subpart 2 Monthly Caseworker Visit (MCV) funds the state requests.

a) Enter the estimated amount of funds to be spent on administration. This cannot exceed 10 percent of the total MCV request entered on line 8a. A warning will display if the amount entered is greater than 10 percent of the requested amount. The amount reported in 8a is a subset of line 8.

9. Child Abuse Prevention and Treatment Act (CAPTA) (applies to STATES only): Enter the amount of CAPTA State Grant funds the state requests.

10. Title IV-E John H. Chafee Foster Care Program for Successful Transition to Adulthood (Chafee) funds: Enter the amount of Chafee funds that the state or tribe requests.

a) At state or tribe option, indicate the estimated amount of the funds to be spent for room and board for eligible youth. This cannot exceed 30 percent of total Chafee request entered on line 10a. A warning will display if the amount entered is greater than 30 percent of the requested amount. The amount reported in 10a is a subset of line 10.

11. Title IV-E Funds Allotted under Section 477 for the Education and Training Vouchers (ETV) Program: Enter the amount of ETV funds that the state or tribe requests.

Items 12 and 13 are addressed under the “Reallotment Request Section”

14. Certification: This report must be signed, titled, 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, Chafee and ETV programs, and, for states only, the CAPTA program, is required. By signing this form, the state/tribal official assures that the state/tribe will meet all applicable match requirements.

Reallotment Request Section:

The section for reallotments pertains to the current fiscal year, not the future year for which funds are being requested. This section should be blank on a “new” request for future year funding.

As funds are available, the Administration for Children and Families (ACF) is able to reallot unneeded portions of state and tribal allotments of title IV-B funds and Chafee funds to other states and eligible tribes so that the total appropriation remains available for program purposes. In order for a state or tribe to be awarded a portion of these funds, or for funds to be released, ACF must have a reallotment request for the current year on file.

The identification of funds that will not be utilized and requests for additional funds occurs mid-year of the current fiscal year and must be submitted as a stand-alone document, separate from the “new” request for funding, and may be submitted independently of the CFSP/APSR. These requests will be sent immediately from the Children’s Bureau (CB) Regional Offices (ROs) to the CB Central Office (CO) for the Office of Grants Management to process so that any available appropriated funds may be realloted timely.

When submitting a request for reallotment, complete a separate CFS-101 Part I with a submission type of “reallotment” checked. Fill in items 1-5 and the applicable cells in items 12 and/or 13, then have it signed, titled, and dated by the authorized agency official. Submit it as a separate file named “State/tribal organization name FY [year] Reallotment” with the name of the state or tribe submitting the file clearly identified. This will ensure a timely review and submission of the request to the CB CO.

Note: A reallotment request may be submitted to the RO at any time prior to, or on, June 30th, independent of the CFSP/APSR submission. However, it must be submitted as a separate file from the future year set of CFS-101 forms.

12. Identification of Surplus Funds for Reallotment: In the appropriate cell, enter the amount of federal CWS, PSSF, MCV, Chafee, and/or ETV funds that the state or tribe will not utilize.

13. Request for additional funds from Reallotment: In the appropriate cell, enter the amount of additional federal CWS, PSSF, MCV, Chafee, and ETV funds that the state or tribe is requesting, should additional funds become available. Note: In requesting additional funds, states and tribes should remember that 25 percent state or tribal non-federal match will be required for the additional funds received under CWS, PSSF, and MCV; a 20 percent state or tribe non-federal match will be required for the additional funds received under Chafee and ETV.

CFS-101, Part II Instructions: Annual Estimated Expenditure Summary of Child and Family Services Funds

Important Note on Completing the CFS-101, Part II Form: This form has been designed to ensure compliance with Federal requirements to make electronic information posted on websites accessible to people with disabilities. The form includes cells in columns (A) through (H) that have been prepopulated with a dash (-). To report data in these columns, replace the dash (-) with the appropriate numeric dollar amount. A zero (0) entered will revert to a dash (-). Columns (I) through (L) have also been prepopulated with a dash (-). To report data for the cells in these columns, type over the dash (-) with the applicable information. If no information is being reported in a cell, the cell should not be changed in any way.

This form details the state or tribal agency's estimated (planned) expenditures on Child and Family Services programs, including the title IV-B programs, the Child Abuse Treatment and Prevention Act (CAPTA) State grant, the John H. Chafee Foster Care Program for Successful Transition to Adulthood (Chafee) and Education and Training Vouchers (ETV) program for the next federal fiscal year. This information is an integral part of the Child and Family Services Plan and should be discussed together by the Children’s Bureau Regional Office, State Agency Representatives, and tribes as part of joint planning. States and tribes should list estimated expenditures and other information in the category that best fits their programs.

• Name of State or Indian Tribal Organization: No entry is needed. This field auto-fills from the CFS-101, Part I. Please verify that the entry is correct.

Services/Activities:

For each of the services/activities listed, indicate in the appropriate columns the estimated expenditures by program, the estimated number of clients to be served, the population to be served, and the geographic area to be served.

1. Protective Services: Services designed to prevent or remedy the abuse, neglect, or exploitation of children. Services include investigation and emergency medical services, emergency shelter, legal action, developing case plans, counseling, assessment/evaluation of family circumstances, arranging alternative living arrangements, preparing for foster placement, if needed, and case management and referral to service providers.

2. Crisis Intervention (Family Preservation): Services for children and families designed to help families (including adoptive and extended families) at risk or in crisis. The types of services within this category include:

• Service programs designed to help children, where safe and appropriate, return to families from which they have been removed; or be placed for adoption, with a legal guardian, or, if adoption or legal guardianship is determined not to be safe and appropriate for a child, in some other planned, permanent living arrangement;

• Pre-placement preventive services programs, such as intensive family preservation programs, designed to help children at risk of foster care placement remain safely with their families;

• Service programs designed to provide follow-up care to families to whom a child has been returned after a foster care placement;

• Respite care of children to provide temporary relief for parents and other caregivers (including foster parents);

• Services designed to improve parenting skills (by reinforcing parents’ confidence in their strengths, and helping them to identify where improvement is needed and to obtain assistance in improving those skills) with respect to matters such as child development, family budgeting, coping with stress, health, and nutrition;

• Infant safe haven programs to provide a way for a parent to safely relinquish a newborn infant at a safe haven designated pursuant to a state law; and

• Case management services designed to stabilize families in crisis such as transportation, assistance with housing and utility payments, and access to adequate health care.

3. Prevention and Support Services (Family Support): Community-based services which:

• Promote the safety and well-being of children and families;

• Increase the strength and stability of families (including adoptive, foster, and extended families);

• Support and retain foster families so they can provide quality family-based settings for children in foster care;

• Increase parents' confidence and competence in their parenting abilities;

• Afford children a safe, stable, and supportive family environment;

• Strengthen parental relationships and promote healthy marriages; and

• Enhance child development, including through mentoring.

These services may include respite care for parents and other caregivers; early developmental screening of children to assess the needs of these children and assistance in obtaining specific services to meet their needs; mentoring, tutoring, and health education for youth; a range of center-based activities (informal interactions in drop-in centers, parent support groups); services designed to increase parenting skills; and counseling and home visiting activities.

3. Family Reunification Services: Services and activities that are provided to a child who is removed from the child's home and placed in a foster family home or a child care institution or a child who has been returned home and to the parents or primary caregiver of such a child, in order to facilitate the reunification of the child safely and appropriately within a timely fashion and to ensure the strength and stability of the reunification. In the case of a child who has been returned home, the service and activities shall only be provided during the 15-month period that begins on the date that the child returns home. The services and activities that may be provided are the following:

• Individual, group, and family counseling;

• Inpatient, residential, or outpatient substance abuse treatment services;

• Mental health services;

• Assistance to address domestic violence;

• Services designed to provide temporary child care and therapeutic services for families, including crisis nurseries;

• Peer-to-peer mentoring and support groups for parents and primary caregivers;

• Services and activities designed to facilitate access to and visitation of children by parents and siblings; and

• Transportation to or from any of the services and activities described above.

5. Adoption Promotion and Support Services: Services and activities designed to encourage more adoptions out of the foster care system, when adoptions promote the best interests of children, including such activities as pre- and post-adoptive services and activities designed to expedite the adoption process and support adoptive families.

6. Other Service Related Activities: Planning, service coordination, preparation or follow-up to service delivery such as the recording of progress notes or other activities, other than direct services or administration, supporting the delivery of services under the program etc.

7. Foster Care Maintenance: Expenditures for “room and board” for children/youth in foster care.

a) Foster Family and Relative Foster Care: Payments to cover food, clothing, shelter, daily supervision, school supplies, a child's personal incidentals, liability insurance with respect to a child, and reasonable travel to the child's home for visitation and reasonable travel for the child to remain in the school in which the child is enrolled at the placement in foster care as well as the cost of providing these services.

b) Group/Institutional Care: This includes the reasonable costs of administration and the operation of institutional/group home care that are required to provide food, clothing, shelter, daily supervision, school supplies, a child's personal incidentals, liability insurance with respect to a child, and reasonable travel to the child's home for visitation, the cost of reasonable travel for the child to remain in the same school he or she was attending prior to placement in foster care and the cost of the items themselves.

8. Adoption Subsidy Payments: Funds provided to adoptive parents on a recurring and non-recurring basis to assist in the support of children with special needs.

9. Guardianship Assistance Payments: Funds provided to kinship legal guardians on a recurring and non-recurring basis to assist in the support of children formerly in foster care placed in their care.

10. Independent Living Services: Services designed to help youth who experienced foster care at age 14 or older, youth expected to remain in foster care until the age of 18, youth who after age 16 leave foster care for kinship guardianship or adoption, and former foster care recipients between 18 and 21 years of age (or 23 years of age, as applicable), make the transition to self-sufficiency. Services may include education, career exploration, vocational training, job placement and retention, training in daily living skills, training in budgeting and financial management skills, substance abuse prevention, and preventive health activities.

States and tribes are allowed to expend up to 30 percent of their allotments under the Chafee Program for room and board (including rental deposits, utilities and other expenses that may be included with rent) for children who have left foster care because they have attained 18 years of age, and who have not yet attained 21 years of age (or 23 years of age, as applicable).

11. Education and Training Vouchers: Include the amount of funds the state or tribe plans to utilize for the Education and Training Vouchers (ETV) program in this line item.

12. Administrative Costs: Identifies the amount of funds the state or tribe plans to utilize for administrative costs. No entry is needed. The amounts for title IV-B, subparts 1 and 2, and MCV will autofill from the entries on Part I.

• For states and tribes, administrative costs under title IV-B, subpart 1 may not be more than ten percent of title IV-B, subpart 1 expenditures. Allowable costs for title IV-B, subpart 1 may include procurement, payroll processing, personnel functions, management, maintenance and operation of space and property, data processing and computer services, accounting, budgeting, auditing, and travel expenses. Allowable costs may also include indirect costs allocable in accordance with the agency's approved cost allocation plan (45 CFR 1357.32(h)). Applicable costs exclude administrative costs related to the provision of services by caseworkers or the oversight of programs funded under Title IV-B, subpart 1 (Section 422(c)(1) of the Act).

• For states only, administrative costs under title IV-B, subpart 2 (including Monthly Caseworker Visit grants) cannot be more than ten percent of title IV-B, subpart 2 expenditures. Allowable costs for title IV-B, subpart 2 may include, but are not limited to procurement, payroll processing, personnel functions, management, maintenance and operation of space and property, data processing and computer services, accounting, budgeting, and auditing. Allowable costs may also include indirect costs allocable in accordance with the agency's approved cost allocation plan (45 CFR 1357.32(h)).

13. Foster Parent Training and Recruitment: Includes the cost of short-term training to increase foster parent's ability to provide assistance and support to foster and adoptive children, and those costs associated with/resulting from the recruitment of potential foster parents.

14. Adoptive Parent Training and Recruitment: Includes the cost of short-term training to increase adoptive parent's ability to provide assistance and support to foster and adoptive children, and those costs associated with/from the recruitment of potential adoptive parents.

15. Child Care Related to Employment/Training: Includes licensed day care purchased for the purpose of supporting the employment of one or both of the parents.

16. Staff and External Partners Training: Includes the cost of short and long-term training to increase the ability of staff and external partners [other than foster/adoptive parents (see #13 & #14)] to provide assistance and support to children and families, but does NOT include the costs specifically related to supporting the monthly caseworker visit requirement (see #17 below).

17. Caseworker Retention, Recruitment & Training: Includes costs related to supporting monthly caseworker visits with children who are in foster care under the responsibility of the state, with an emphasis on improving caseworker decision making on the safety, permanency, and well-being of foster children and on activities designed to improve retention, recruitment, and training of caseworkers.

18. Total: No entry is needed. A formula has been entered to display the sum of lines 1 through 17 for each grant.

19. Totals from Part I: No entry is needed. The requested amount for each grant from the CFS-101, Part I will autofill in the respective columns.

20. Difference: No entry is needed. The field displays the difference of line 19 (amount entered on Part I) minus line 18 (total of lines on Part II) for each grant. If there is a number other than $0 on this line for any column, this means that the planned breakout of how funds are to be spent is either greater or less than the total amount entered on Part I for that program. Reduce or increase the amounts within the column accordingly to assure that the difference is $0 prior to submitting the CFS 101s to the Children’s Bureau.

21. Population Data: Indicate where the population data can be found, in columns I, J, K, and L on the Part II or in the CFSP/APSR narrative. This information is required for all CFSP/APSR submissions.

Estimated Expenditures:

Columns A-G. For each Federal program indicated in columns (A) through (G) from which the state or tribe requests funding, enter the amount estimated to be spent for each service/activity. The amounts for any of the spending areas on the Part II for PSSF cannot exceed the amount of the request on the Part I. Note: Column (G) [Title IV-E] refers to the title IV-E Foster Care, Adoption Assistance and Guardianship Assistance programs only.

Note: Distribution of PSSF funds in column B on Part II auto-fills from the CFS-101, Part I. These formulas may be overwritten by entering a different amount in the specific cell. This should only occur if some of the service/activity funds are being distributed to the training cells (B13, B14, and B16) or cell B17 for Caseworker Retention, Recruitment, and Training. The amounts in items B2-B6 should not exceed the amounts on Part I for items 7a-f.

Reminders for Columns A-G:

• Hardcode all numbers entered (no formulas).

• Break all links and references to other agency worksheets or workbooks.

• Do not round to the $ thousands or $ millions.

• If there is an amount other than “$0” in the “difference” row (line 20), the estimated expenditures in the service/activities must be adjusted.

Column H. State, Local, Tribal, and Donated Funds: Enter the estimated amount of state, local, tribal, and donated funds to be expended, even if they are not used to match federal funds. Tribal funds received from the Bureau of Indian Affairs (BIA) for child welfare purposes should be entered in this column. Amounts entered in this column should reflect overall programmatic support of the child welfare program, and not only the required non-federal match. This column is required to be completed by all applicants.

The following information must be provided in the CFSP/APSR and may be provided on the CFS-101 Part II or in the narrative of the CFSP/APSR. Mark the appropriate box for Item 21, Population Data, to indicate where this information can be found.

Columns I and J. Estimated Number to be Served: Estimate, as accurately as possible, the number of individuals and families to be served by service/activity with the total estimated funding indicated.

Column K. Population to be Served: Indicate the population that has been targeted for the designated services. Targeting 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; or

• Families in crisis.

Column L. Geographic Area to be Served: Indicate both the number and type of areas identified within the state or tribal lands where services are to be provided for each program. Areas may include specific regions, counties, cities, communities, census tracts, or neighborhoods. For example, if the agency is operating family preservation programs in six counties, indicate by noting "6 counties"; if the agency is operating 12 community-based family support programs, indicate by noting "12 communities".

CFS-101, Part III Instructions: Expenditures for Title IV-B, Subparts 1 and 2, John H. Chafee Foster Care Program for Successful Transition to Adulthood, and Education and Training Voucher (ETV) Program

The CFS-101, Part III report captures information on the actual expenditures for the most recently closed grant award year. Federal funds for the programs identified above are awarded to states and tribes on a yearly basis, but may be spent over a 2-year period ending on September 30 of the year following the fiscal year (FY) for which they were awarded. For the CFS-101 reports submitted with the FY 2022 APSR, the reporting year is the FY 2019 grant allocation, which had an expenditure period from October 1, 2018, to September 30, 2020. Therefore, any fiscal year 2019 funds must have been obligated during that 2-year period of time and subsequently reported on this form.

Important Note on Completing the CFS-101, Part III Form: This form has been designed to ensure compliance with Federal requirements to make electronic information posted on websites accessible to people with disabilities. The form includes cells in columns (A) through (H) that have been prepopulated with a dash (-). To report data in these columns, replace the dash (-) with the appropriate numeric dollar amount. A zero (0) entered will revert to a dash (-). Columns (I) through (L) have also been prepopulated with a dash (-). To report data for the cells in these columns, type over the dash (-) with the applicable information. If no information is being reported in a cell, the cell should not be changed in any way.

Reminders on completing the CFS-101, Part III:

• Hardcode all numbers entered (no formulas).

• Break all links and references to other agency worksheets or workbooks.

• Do not round to the $ thousands or $ millions.

• Amounts for the "estimate" (original planned spending) column can be found in the previously approved CFS 101, Part I for the fiscal year being reported on.

The following four fields have been auto-filled from the Part I. No entry is needed, but please verify that the information is correct (make any corrections on the Part I).

1. Name of State or Indian Tribal Organization

2. Address

2. EIN

2. DUNS

2. Submission Type: Indicate if this is a new or revised expenditure report. A submission is “NEW” until signed by the Children’s Bureau Central Office Official.

Column A. Expenditure Information: Enter the amount of actual expenditures for each of the programs for the reporting year.

2. Total title IV-B, subpart 1 funds: Enter the actual expenditures of title IV-B, subpart 1 Federal funds for the designated fiscal year for Child Welfare Services. The required 25 percent match should not be reflected on this form.

a) Enter the actual expenditures of title IV-B, subpart 1 funds for administration. This cannot not exceed 10 percent of the title IV-B, subpart 1 total expenditures. A warning will display if the amount entered is greater than 10 percent of the total expended amount. The amount reported in 6a is a subset of line 6.

2. Total title IV-B, subpart 2 (PSSF) funds: For TRIBES only: If PSSF funding was received for the reporting year, amounts should be entered in line 7. (States do not complete line 7, but must complete lines 7a – f.)

Tribes are not required to provide the breakout for the use of funds, but may opt to complete lines 7a-f. Tribes should select the option of completing either a) line 7 only, or b) lines 7a-f. Note that the ‘total’ lines, line 7 and 7g, are not connected in any way.

7a-f. Breakout of title IV-B, subpart 2 (PSSF) funds: States must complete lines 7a–f. Completion of lines 7a-f is optional for tribes. The required 25 percent match should not be reflected on this form.

For the designated year, enter in the actual expenditures for:

a) Family Preservation Services;

b) Family Support Services;

c) Family Reunification Services;

d) Adoption Promotion and Support Services;

e) Other service related activities (e.g. planning); and

f) Administrative costs. States’ administrative costs cannot exceed 10 percent of the total Federal expenditures for title IV-B, subpart 2. (This limitation does not apply to tribes.) A warning will display if the amount entered is greater than 10 percent of the total expended amount.

2. Total title IV-B subpart 2, Monthly Caseworker Visit (MCV) funds (States only): Enter the actual expenditures allotted for the designated fiscal year.

a) Enter the actual administrative expenditures for Monthly Caseworker Visit funds allotted (States only). Administrative costs cannot exceed 10 percent of the total expenditures for MCV. A warning will display if the amount entered is greater than 10 percent of the total expended amount. The amount reported in 8a is a subset of line 8.

2. John H. Chafee Program for Successful Transition to Adulthood (Chafee) funds: At state/tribe option, enter the actual expenditures of Chafee funds allotted for independent living activities for the designated fiscal year. The required 20 percent match should not be reflected on this form.

a) Enter the actual expenditures for room and board for eligible youth. This cannot exceed 30 percent of Chafee funds. A warning will display if the amount entered is greater than 30 percent of the total expended amount. The amount reported in 9a is a subset of line 9.

2. Education and Training Vouchers (ETV) Program: At state/tribe option, enter the actual expenditures of Education and Training Voucher funds allotted for the designated fiscal year. The required 20 percent match should not be reflected on this form.

Columns B - E. Population and Geographic Data: For each federal program listed in rows 6-10, as applicable, indicate as accurately as possible, the number of individuals and the number of families served¹, the population served², and the geographic area where services were provided³. This information must be reported on the CFS-101 Part III per section 432(a)(8)(B) of the Social Security Act for both title IV-B, subpart 1 and title IV-B, subpart 2.

2. Certification: This report must be signed, dated, and titled 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, Chafee and ETV, and, for states only, MCV programs, must be included.

By signing this form, the state/tribal official certifies that all figures provided on this form are accurate.

Save and name all CFS-101 sets (PDF for all; Excel workbook for states) as “State/Tribe name FY [year] CFS-101s” so that the name of the state or tribe submitting the file is clearly identified.

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.

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.

3Indicate 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.

18 2022 APSR