| CFS-101, Part I: Annual Budget Request for Title IV-B, Subpart 1 & 2 Funds, CAPTA, CHAFEE, and ETV and Reallotment for Current Federal Fiscal Year Funding | |||||
| For Federal Fiscal Year 2024: October 1, 2023 through September 30, 2024 | |||||
| 1. Name of State or Indian Tribal Organization AND Department/Division: | 3. EIN: | ||||
| 4. UEI: | |||||
| 2. Address: | (insert mailing address for grant award notices in the two rows below) | ||||
| 5. Submission Type: (mark X next to option) | |||||
| - New | |||||
| a) Contact Name and Phone for Questions: | - Reallotment | ||||
| b) Email address for grant award notices: | |||||
| REQUEST FOR FUNDING for FY 2024: | |||||
| 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. | |||||
| Hardcode all numbers; no formulas or linked cells. | |||||
| 6. Requested title IV-B Subpart 1, Child Welfare Services (CWS) funds: | $0 | ||||
| a) Total administrative costs (not to exceed 10% of the CWS request) | $0 | ||||
| 7. Requested title IV-B Subpart 2, Promoting Safe and Stable Families (PSSF) funds and estimated expenditures: | % of Total | $0 | |||
| a) Family Preservation Services | #DIV/0! | $0 | |||
| b) Family Support Services | #DIV/0! | $0 | |||
| c) Family Reunification Services | #DIV/0! | $0 | |||
| d) Adoption Promotion and Support Services | #DIV/0! | $0 | |||
| e) Other Service Related Activities (e.g. planning) | #DIV/0! | $0 | |||
| f) Administrative Costs (STATES: not to exceed 10% of the PSSF request; TRIBES: no maximum %) | #DIV/0! | $0 | |||
| g) Total itemized request for title IV-B Subpart 2 funds: NO ENTRY: Displays the sum of lines 7a-f. | #DIV/0! | $0 | |||
| 8. Requested Monthly Caseworker Visit (MCV) funds: (For STATES ONLY) | $0 | ||||
| a) Total administrative costs (not to exceed 10% of MCV request) | $0 | ||||
| 9. Requested Child Abuse Prevention and Treatment Act (CAPTA) State Grant: (STATES ONLY) | $0 | ||||
| 10. Requested John H. Chafee Foster Care Program for Successful Transition to Adulthood: (Chafee) funds: | $0 | ||||
| a) Indicate the amount to be spent on room and board for eligible youth (not to exceed 30% of Chafee request). | $0 | ||||
| 11. Requested Education and Training Voucher (ETV) funds: | $0 | ||||
| REALLOTMENT REQUEST(S) for FY 2023: | |||||
| Complete this section for adjustments to current year awarded funding levels. This section should be blank for any "NEW" submission. | |||||
| 12. Identification of Surplus for Reallotment: | |||||
| a) Indicate the amount of the State’s/Tribe’s FY 2023 allotment that will not be utilized for the following programs: | |||||
| CWS | PSSF | MCV (States only) | Chafee Program | ETV Program | |
| $0 | $0 | $0 | $0 | $0 | |
| 13. Request for additional funds in the current fiscal year (should they become available for re-allotment): | |||||
| CWS | PSSF | MCV (States only) | Chafee Program | ETV Program | |
| $0 | $0 | $0 | $0 | $0 | |
| 14. Certification by State Agency and/or Indian Tribal Organization: | |||||
| The State agency or Indian Tribal Organization submits the above estimates and request for funds under title IV-B, subpart 1 and/or 2, of the Social Security Act, CAPTA State Grant, Chafee and ETV programs, and agrees that expenditures will be made in accordance with the Child and Family Services Plan, which has been jointly developed with, and approved by, the Children's Bureau. | |||||
| Signature of State/Tribal Agency Official | Signature of Federal Children's Bureau Official | ||||
| Title | Title | ||||
| Date | Date | ||||
| CFS-101 Part II: Annual Estimated Expenditure Summary of Child and Family Services Funds | ||||||||||||
| Name of State or Indian Tribal Organization: | 0 | For FY 2024: OCTOBER 1, 2023 TO SEPTEMBER 30, 2024 | ||||||||||
| No entry required in the black shaded cells | ||||||||||||
| SERVICES/ACTIVITIES | (A) IV-B Subpart 1-CWS |
(B) IV-B Subpart 2-PSSF |
(C) IV-B Subpart 2- MCV |
(D) CAPTA |
(E) CHAFEE |
(F) ETV |
(G) TITLE IV-E |
(H) STATE, LOCAL, TRIBAL, & DONATED FUNDS |
(I) Number Individuals To Be Served |
(J) Number Families To Be Served |
(K) Population To Be Served (narrative) |
(L) Geographic Area To Be Served |
| 1.) PROTECTIVE SERVICES | $- | $- | $- | - | - | - | - | |||||
| 2.) CRISIS INTERVENTION (FAMILY PRESERVATION) | $- | $- | $- | $- | - | - | - | - | ||||
| 3.) PREVENTION & SUPPORT SERVICES (FAMILY SUPPORT) | $- | $- | $- | $- | - | - | - | - | ||||
| 4.) FAMILY REUNIFICATION SERVICES | $- | $- | $- | $- | - | - | - | - | ||||
| 5.) ADOPTION PROMOTION AND SUPPORT SERVICES | $- | $- | $- | - | - | - | - | |||||
| 6.) OTHER SERVICE RELATED ACTIVITIES (e.g. planning) | $- | $- | $- | - | - | - | - | |||||
| 7.) FOSTER CARE MAINTENANCE: (a) FOSTER FAMILY & RELATIVE FOSTER CARE |
$- | $- | $- | - | - | - | - | |||||
| (b) GROUP/INST CARE | $- | $- | $- | - | - | - | - | |||||
| 8.) ADOPTION SUBSIDY PYMTS. | $- | $- | $- | - | - | - | - | |||||
| 9.) GUARDIANSHIP ASSISTANCE PAYMENTS | $- | $- | $- | - | - | - | - | |||||
| 10.) INDEPENDENT LIVING SERVICES | $- | $- | $- | - | - | - | - | |||||
| 11.) EDUCATION AND TRAINING VOUCHERS | $- | $- | $- | - | - | - | - | |||||
| 12.) ADMINISTRATIVE COSTS | $- | $- | $- | $- | $- | |||||||
| 13.) FOSTER PARENT RECRUITMENT & TRAINING | $- | $- | $- | $- | $- | |||||||
| 14.) ADOPTIVE PARENT RECRUITMENT & TRAINING | $- | $- | $- | $- | $- | |||||||
| 15.) CHILD CARE RELATED TO EMPLOYMENT/TRAINING | $- | $- | $- | - | - | - | - | |||||
| 16.) STAFF & EXTERNAL PARTNERS TRAINING | $- | $- | $- | $- | $- | $- | $- | |||||
| 17.) CASEWORKER RETENTION, RECRUITMENT & TRAINING | $- | $- | $- | $- | $- | |||||||
| 18.) TOTAL | $- | $- | $- | $- | $- | $- | $- | $- | ||||
| 19.) TOTALS FROM PART I | $0 | $0 | $0 | $0 | $0 | $0 | 21.) Population data required in columns I - L can be found: (mark X below the option) | |||||
| 20.) Difference (Part I - Part II) | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | On this form | In the APSR Narrative | ||||
| (If there is an amount other than $0.00 in Row 20, adjust amounts on either Part I or Part II. A red value in parentheses ($) means Part II exceeds the amount on Part I.) | ||||||||||||
| CFS-101, PART III: Annual Expenditures for Title IV-B, Subparts 1 and 2, Chafee Program, and Education And Training Voucher | |||||
| Reporting on Expenditure Period For Federal Fiscal Year 2021 Grants: October 1, 2020 through September 30, 2022 | |||||
| No entry required in the black shaded cells | |||||
| 1. Name of State or Indian Tribal Organization: | 2. Address: | 3. EIN: | |||
| 0 | 0 | 4. UEI: | |||
| 5. Submission Type: (type New or Revision) | 0 | ||||
| Description of Funds | (A) Actual Expenditures for FY 21 Grants (whole numbers only) | (B) Number Individuals served |
(C) Number Families served |
(D) Population served (narrative) | (E) Geographic area served |
| 6. Total title IV-B, subpart 1 (CWS) funds: | $- | - | - | - | - |
| a) Administrative Costs (not to exceed 10% of CWS allotment) | $- | - | - | - | - |
| 7. Total title IV-B, subpart 2 (PSSF) funds: Tribes enter amounts for Estimated and Actuals, or complete 7a-f. | $- | - | - | - | - |
| a) Family Preservation Services | $- | ||||
| b) Family Support Services | $- | ||||
| c) Family Reunification Services | $- | ||||
| d) Adoption Promotion and Support Services | $- | ||||
| f) Administrative Costs (FOR STATES: not to exceed 10% of PSSF spending) |
$- | ||||
| g) Total title IV-B, subpart 2 funds: NO ENTRY: This line displays the sum of lines a-f. |
$- | ||||
| 8. Total Monthly Caseworker Visit funds: (STATES ONLY) | $- | ||||
| a) Administrative Costs (not to exceed 10% of MCV allotment) | $- | ||||
| 9. Total Chafee Program for Successful Transition to Adulthood Program (Chafee) funds: (optional) | $- | - | - | - | - |
| a) Indicate the amount of allotment spent on room and board for eligible youth (not to exceed 30% of Chafee allotment) | $- | - | - | - | - |
| 10. Total Education and Training Voucher (ETV) funds: (Optional) | $- | - | - | - | - |
| 11. Certification by State Agency or Indian Tribal Organization: The State agency or Indian Tribal Organization agrees that expenditures were made in accordance with the Child and Family Services Plan which was jointly developed with, and approved by, the Children's Bureau. | |||||
| Signature of State/Tribal Agency Official | Signature of Federal Children's Bureau Official | ||||
| Title | Date | Title | Date | ||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |