Form CB-496: Title IV-E Programs Quarterly Financial Report

INSTRUCTIONS FOR COMPLETION OF FORM CB - 496

TITLE IV-E PROGRAMS QUARTERLY FINANCIAL REPORT

(Foster Care, Adoption Assistance, Guardianship Assistance,

Prevention Services and Kinship Navigator Programs

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: Through this information collection, ACF is gathering quarterly and annual information on the financial operations of the title IV-E Foster Care, Adoption Assistance, Guardianship Assistance, Prevention Services and Kinship Navigator Programs. The purpose of this information collection is to award funds, determine the allowability of reported expenditures and to provide reports to Congress. Public reporting burden for this collection of information is estimated to average 25 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 (sections 471(a)(6), 471(a)(7), and 474(a) and (b) of the Social Security Act. This collection of information is required to retain a benefit (45 CFR 201.5 as made applicable through 45 CFR 1355.30(n)(2). 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 0970-0510 and the expiration date is 05/31/2021. If you have any comments on this collection of information, please contact Jan Rothstein, Children’s Bureau, Administration for Children and Families, by email at jan.rothstein@acf.hhs.gov.

Compendium

Topic Page

Form CB-496 General Instructions – All Parts ………………………………………………... 3

Part 1: Expenditures and Estimates (Including Caseload Data)

Part 1 Definitions – Financial Information ………………………………………………………5

Part 1 Definitions – Program Related Information ……………………………………………. 8

Part 1 Report Heading Information ……………………………………………………………..16

SECTION A: FOSTER CARE

General Guidance ………………………………………………………………………………...16

Line by Line Instructions – Maintenance Payments (Lines 1a – 4) ………………………….18

Line by Line Instructions – Administration (Lines 5 – 10c) ………………………………….. 21

Line by Line Instructions – CCWIS & Non-CCWIS (Lines 11a – 14b) ………………….…..24

Line by Line Instructions – Training (Line 15) ………………………………………………....26

Line by Line Instructions – Demonstration Projects (Line 16a) ……………………………...27

Line by Line Instructions – Post-Demonstration Costs (Line 16b) …….……………………. 27

Line by Line Instructions – Totals (Lines 17 – 19) …………………………………………… 27

SECTION B: ADOPTION ASSISTANCE

Line by Line Instructions (Lines 20 – 28) ……………………………………………………….28

SECTION C: GUARDIANSHIP ASSISTANCE

Line by Line Instructions (Lines 29 – 37) ……………………………………………………….31

SECTION D: PREVENTION SERVICES AND KINSHIP NAVIGATOR PROGRAMS

General Guidance …………………………………………………………………………………35

Line by Line Instructions – Prevention Services (Lines 38 – 43) …………………………….37

Line by Line Instructions - Kinship Navigator (Lines 44 – 47) ………………………………..39

SECTION E: AVERAGE MONTHLY NUMBER OF CHILDREN ASSISTED

Line by Line Instructions – Foster Care (Lines 48a – 52) ……………………………………. 40

Line by Line Instructions – Adoption Assistance (Lines 53 – 55) …………………………… 43

Line by Line Instructions – Guardianship Assistance (Lines 56 – 59) ……………………… 43

Line by Line Instructions – Prevention Services (Line 60) ……………………………………44

Line by Line Instructions – Kinship Navigator (Line 61) ……………………………………… 44

Topic Page Part 2: Prior Quarter Expenditure Adjustments

Part 2 General Instructions & Report Heading …………………………………………………45

Part 2 Sections Guidance ……………………………………………………………………….. 45

Part 2 Columns Guidance ………………………………………………………………………..46

Part 2 Funding Category Codes ……………………………………… ………………………...47

Part 3: Demonstration Projects and Foster Care Post-Demonstration Costs & Funding Certainty Grant Calculations

Part 3 Demonstration Projects General Instructions………………………………………….. 49

Part 3 Foster Care Post-Demonstration Costs & Funding Certainty Grant Calculations

General Instructions……………………………………..……………………………………….. 51

Part 3 Definitions …………………………………………………………………………………. 53

Part 3 Report Heading Information …………………………………………………………….. 55

Part 3 Demonstration Projects Sections Overview

Section A – Title IV-E Allowable and Waiver-Based Demonstration Project Costs ………..55

Section B - Cost-Neutrality Calculations ………………………………………………………. 56

Section C – Project Savings/Unused Allocations …………………………………………….. 56

Section D - Fundable Claims/Estimates ……………………………………………………….. 56

Part 3 Post-Demonstration & Funding Certainty Sections Overview

Section E – Foster Care Post-Demonstration Costs………………………………………….. 57

Section F – Funding Certainty Grant Calculations……………………………………………..57

Part 3 Line by Line Instructions

I. Experimental Design Projects (Lines 1a – 4, 11A 16b & 23a – 23b)………………………57

II. Capped Allocation Design Projects (Lines 5a – 8, 17a – 22c & 24a – 24c) ……………..66

III. All Program Projects (Lines 9 – 10 & 25a – 25d) …………………………………………. 80

IV. Foster Care Post-Demonstration Costs (Lines 26a – 28b) ……………………………… 81

V. Funding Certainty Grant Calculations (Lines 29 – 31c) ……..…………………………… 86

Part 4: Annual Adoption Savings Calculation and Accounting Report

Part 4 General Instructions ……………………………………………………………………… 88

Part 4 Definitions …………………………………………………………………………………. 89

Part 4 Report Heading Information …………………………………………………………….. 91

Part 4 Sections Overview ……………………………………………………………………….. 91

Part 4 Line by Line Instructions ………………………………………………………………… 92

Form CB-496 General Instructions – All Parts

Applicability: Completion of this report is required by each State and Indian Tribe, Tribal organization and Tribal consortia (hereafter “Tribe”) with an approved title IV-E plan to administer the Foster Care, Adoption Assistance, Guardianship Assistance, Prevention Services or Kinship Navigator Program under title IV-E of the Social Security Act (hereafter “the Act”). Some information required on this report is applicable ONLY to State programs or ONLY to Tribal programs. These items are clearly identified on the form and in these instructions.

The information reported on this form is reviewed by various components of the Administration for Children and Families (ACF) to award funds, determine the allowability of reported expenditures and to provide reports to Congress. Determinations regarding whether reported expenditures are eligible for Federal funding under title IV-E will be made in accordance with applicable Federal statute, regulations and policy.

These instructions are intended to assist in the completion of this form and clarify the applicable Federal statutes, regulations and policies. Where a conflict exists, this form and these instructions do not supersede such documents.

Reporting Format: Round all monetary entries to the nearest dollar, do not include cents. Data regarding the number of children assisted should also be rounded to the nearest whole number.

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Due Dates: Parts 1-3 of this form must be submitted quarterly within 30 days of the end of each fiscal quarter, i.e., no later than January 30, April 30, July 30 and October 30, respectively. Part 4 of this form must be submitted annually within 30 days of the end of the fourth quarter of the federal fiscal year, i.e., no later than October 30th.

Submission: States and Tribes are required to submit this form electronically through the ACF On-Line Data Collection (OLDC) system, which requires pre-registration and the use of an approved digital signature. Once submitted through OLDC, a duplicate paper copy must not be submitted by either mail, email or fax.

For additional information, see Office of Grants Management Action Transmittal, OGM-AT-13-01, dated September 25, 2013. This document also provides instructions on requesting a one-year waiver from online reporting in the event any State or Tribe is able to clearly demonstrate a lack of internet access, computer capacity or other circumstance that prevents electronic filing of Form CB-496. If the request for a waiver is approved, instructions for submitting a paper copy of this report will be provided at that time.

Signatures: This report must be electronically signed and dated by the State or Tribal official responsible for the administration of the title IV- E programs or other official responsible for the financial administration of these programs. The individual signing at the end of Part 1 is certifying to the correctness and accuracy of the information on Parts 1-3 of this reporting form and on any accompanying documents. This individual is also certifying that any amount shown as the Tribal/State share of expenditures is or will be available to meet the non-federal share of expenditures for the quarter indicated as prescribed by law.

For report submissions that also include Part 4, a second electronic signature is required at the end of Part 4. This signature is, likewise, certifying to the correctness and accuracy of the information on Part 4 or on any accompanying documents only. Additionally, the Part 4 certification establishes that the reported expenditures consist of non-federal funds which supplement, not supplant, any federal on non-federal funds used to provide any service under titles IV-B or IV-E.

Variances. (THIS PROVISION IS NOT APPLICABLE TO TRIBES.) On an attached file, States must submit a detailed explanation of any increase or decrease greater than ten percent for data elements reported in columns A or E for any line of Sections A, B, C, or D and for both actual and estimated number of children counts for any line of Section E of Part 1 as compared to the same element on the Part 1 report submitted for the immediately preceding quarter. (See the Part 2 column E instructions for information reporting requirements for any prior quarter adjustments.) The explanation should include but is not limited to details relating to changes in number of children or type of placement, number of staff or administrative activity, or number of trainees or type of training. In addition, upon request, an explanation may be requested for a variance that represents a change of less than the above noted percentage. (See Supportive Documentation below for additional information.)

Supportive Documentation. Upon request, title IV-E agencies must submit documentation in support of current expenditures and prior quarter expenditure adjustments as well as other information reported on this form. Access to documentation supporting title IV-E claims is authorized as per applicable federal regulations at 45 CFR §75.364. Such supportive documentation should be in accordance with applicable federal regulations at 45 CFR §75.302 for financial management and standards for financial management systems. This documentation may include, but is not limited to, readily available accounting records and source documentation, an approved cost allocation plan, cost allocation statistical data such as title IV-E program participation rates or time study results or/and an indirect rate agreement, as applicable. For tribal title IV-E agencies, this request might also include information on claiming variances, where deemed to be significant.

Revisions: If the State or Tribe needs to change or correct its submission of this report after the original copy is submitted by the due date indicated above, a revised report may be submitted. However, a revised Parts 1-3 report will generally not be accepted after the expenditures reported in the original submission have been used in the calculation of a quarterly grant award1 - usually within 90 days after the close of the “current quarter.” Any additional claims or other adjustments that must be reported after that time must be included as a “prior quarter adjustment” on a subsequent “claiming quarter” expenditure report, within the limits of any time constraints imposed by law or regulation. Revisions to the “next quarter” estimates will be accepted only in extraordinary circumstances. (1Note: An exception to this restriction will be made where a delay in the reporting of an increasing adjustment will cause the claim to be filed beyond the two-year filing deadline under Section 1132 of the Act or where the additional reporting is limited to children assisted data in Part 1, Section E.) A Part 4 report may be revised at any time after the original report has been accepted.

For Congressional reporting purposes, no re-submissions, revisions or adjustments of expenditure lines on CB-496 Parts 1-3 reports submitted for any quarter of the fiscal year will be accepted by ACF later than December 31 - 3 months after the end of that Federal fiscal year (FFY). Only data received by ACF as of that date will be used in the publication of statistical data for that fiscal year.

Part 1: Expenditures and Estimates (Including Caseload Data)

Part 1 Definitions

The definitions of terms for purposes of completing Part 1 of the CB-496 listed below are categorized under “Financial Information” and “Program Related Information”. Some of these definitions may also be relevant (unless superseded by further guidance in these instructions) for purposes of completing Part 2 and Part 3 of this report. Each section lists definitions based on the order in which they appear on the CB-496 reporting form.

Financial Information:

Expenditures (Columns A, B, C and D). Expenditures are actual payments made to vendors, service providers and contractors or actual payments for agency administrative, personnel, or other cost items. Include also indirect costs allocable to the quarter being reported in accordance with an approved or pending cost allocation plan or negotiated indirect cost rate.

To be allowable, all amounts reported must be expenditures made under the State or Tribe's approved title IV-E plan for administration, training and systems costs or for payments and provision of services made on behalf of individuals determined as eligible for participation in the title IV-E program. Amounts reported must be in accordance with all applicable statutes, regulations or policies, and, where necessary, using the methodologies in an approved or pending public assistance cost allocation plan (States), an approved child welfare cost allocation methodology (Tribes), negotiated indirect cost rate or other required submission. The terms "expenditure" and "cost" are used interchangeably in these instructions.

Expenditure estimates are not acceptable in these columns. "Advances" of funds to another State or Tribal agency, a local agency or a private entity are not considered expenditures for these purposes. The amounts reported in these columns must be actual, verifiable transactions supported by readily available accounting records and source documentation or an approved cost allocation plan or an indirect rate agreement, as applicable.

Expenditures are considered made on the date the payment occurs, regardless of the date of receipt of the good or performance of the service. For those programs that provide for State or Tribal administration, the date of this transaction by the title IV-E State or Tribal agency governs; for States or Tribes with programs that are administered by a local jurisdiction and are supervised by the State or Tribe, the date of this transaction by the county, city or other local agency governs. Indirect costs are allocable in accordance with the cost allocation plan or indirect rate agreement, and are considered to be “expended” in the quarter to which they are allocated.

Next Quarter Estimates (Columns E and F). In accordance with the provisions of Section 474(b)(1) of the Act, this is the Total and Federal share of expenditures the State or Tribe anticipates will be made in the upcoming quarter. The “Next (Estimating) Quarter” is the quarter about to begin where projected total expenditures and the calculated Federal share are being reported in these columns. These estimates should be based on historical trends, including seasonal, economic or other variations, and should include any costs applicable to a prior quarter for which payments are expected to be made in the next quarter. The ending date of the next quarter is always six months after the ending date of the current quarter.

Part 1 Columns.

• Total (Columns A, C and E). This includes all expenditures and estimates for each cost item, including both Federal and Tribal/State share components.

• Federal Share (Columns B, D and F). This is the Federal portion of expenditures, payments or estimates as reported on each line of this report, as computed using the appropriate Federal Medical Assistance Percentage (FMAP) or Federal financial participation (FFP) rate for each line item as described in these instructions.

• Current Quarter Claims (Columns A and B). This is the Total and the Federal share of expenditures made in or allocated to the "Current (Claiming) Quarter" being reported. The “Current Quarter” is the quarter that just ended, for which expenditures are being reported and for which Federal funds are being claimed in these columns.

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• Prior Quarter Adjustments (Columns C and D). These include the Total and the Federal share of expenditures made in or allocated to a previous quarter that were either unreported or incorrectly reported on an earlier report. A “Prior Quarter” is any quarter that ended prior to the start of the current quarter for which expenditures are being reported and for which Federal funds are being claimed in these columns. The “net” amount – combining increasing and decreasing claims – is reported on each line in Columns C and D. The individual increasing and decreasing claims are detailed and itemized on Part 2 of this report.

• Next Quarter Estimates (Columns E and F). This is the Total and the Federal share of expenditure estimates for the "Next (Estimating) Quarter" being reported. The “Next Quarter” is the quarter that will end six months after the "current (claiming) quarter", for which expenditure estimates are being reported and for which advances of Federal funds are being requested in these columns.

FMAP Rate. A Federal Medical Assistance Percentage (FMAP) rate is used by a State or Tribe in determining the Federal share of expenditures for assistance payments under the Foster Care, Adoption Assistance and Guardianship Assistance programs. Beginning in FFY2027, the FMAP rate will also be used in determining the Federal share of expenditures for services under the Prevention Services program.

State FMAP Rates. These rates are calculated and published annually in the Federal Register by the Department of Health and Human Services pursuant to section 1905(b) of the Act. These rates, ranging from 50 to 83 percent, are based on the relative per capita income of each State.

Tribal FMAP Rates. In accordance with section 474(a) and 479(B)(d) of the Act these rates are calculated for a Federally-recognized Tribe that participates in title IV-E programs either through direct administration with an approved title IV-E Tribal plan or through an agreement or contract with one or more States. The calculation of the Tribal FMAP rate is based on the relative per capita income of each Tribe’s service population.

• When completing this report, any Tribe that directly operates a title IV-E program through an approved title IV-E Tribal Plan will use either its own calculated FMAP rate or the FMAP rate calculated for the State in which it is located, whichever rate is higher.

• When completing this report, any State that operates a title IV-E program that includes Tribal participants through an agreement or contract with that Tribe, will use either its own calculated FMAP rate or the FMAP rate calculated for the Tribe, whichever rate is higher, for those maintenance assistance payments made to the participants from that Tribe. (Where multiple agreements exist with multiple Tribes, this comparison and calculation must be done separately under each agreement.)

FFP Rate. The Federal Financial Participation (FFP) rate applicable to a program or certain cost categories within a program is specified by statute and is used to calculate the Federal share of program expenditures made by the State or Tribe. For example, the Federal share of administrative expenditures for the programs on this report is calculated at the 50 percent FFP rate, while the Federal share of expenditures for certain training is calculated at FFP rates of 75 percent, depending on the nature of the training and the fiscal year in which the costs were incurred.

Non-Federal Share. State or Tribal Share. (Lines 18, 19, 27, 28, 36, 37, 43, 47) In accordance with its approved State or Tribal plan, this is the State’s or Tribe’s required portion of total expenditures reported in Columns A and C. This is also the required portion of the estimated expenditures reported in Column E that the State or Tribe is certifying are or will be available for the non-Federal share of program costs. The Non-Federal share typically consists of grantee appropriated monies raised from non-Federal revenue sources. For Tribal title IV-E Foster Care, Adoption Assistance and Guardianship Assistance programs, a portion of the Non-Federal share may also consist of in-kind expenditures (or contributions) from third party sources. Federal funds specifically authorized by Federal statutes to be used as match for other Federal programs, including the title IV-E program, may constitute Tribal or State share in accordance with the applicable statute.

Third Party In-Kind Expenditures (or Contributions). These include fairly evaluated monetary values (see Federal regulations at 45 CFR 75.306) attributable to items (e.g. plants, equipment, administration) or services used for program purposes and provided by sources other than the agency administering the program.

• Tribes are specifically permitted by statute (Section 479B(c)(1)(D) of the Act) to use third party in-kind expenditures (or contributions) from certain sources as a portion of the Tribal share of administrative and training costs for Foster Care, Adoption Assistance or Guardianship Assistance programs under title IV-E. This option does not apply to the title IV-E Prevention Services and Kinship Navigator programs since these title IV-E programs are not covered under the statutory provision (section 474(a)(3) of the Act) for which authority to use the third party in-kind expenditures (or contributions) is applicable.

• States are not permitted to use third party in-kind expenditures (or contributions) as a source of the State share of funds for the Foster Care, Adoption Assistance or Guardianship Assistance programs under title IV-E. (See Child Welfare Policy Manual, section 8.1F, Q#2). Federal regulations at 45 CFR 1355.30(i) provide a specific exception to the applicability of regulations at 45 CFR 75.306 for these programs. This provision also applies to the title IV-E Prevention Services and Kinship Navigator programs.

Reporting Deadline. In accordance with Section 1132 of the Act and Federal regulations at 45 CFR Part 95 Subpart A, increasing prior quarter adjustments must be reported by the IV-E agency and received by this agency within 2 years of the last day of the fiscal quarter in which the expenditure was made. Unless the title IV-E agency meets one of the criteria for an exception as stated in the regulation, claims for increasing prior quarter adjustments that fail to meet this deadline are subject to disallowance. There is no deadline for submission of decreasing prior quarter adjustments.

Program Related Information:

Federally Recognized Tribe. This includes any Indian Tribe, Band, Nation, or other organized group or community, including any Alaska Native village or regional or village corporation, as defined in or established pursuant to the Alaska Native Claims Settlement Act, which is recognized as eligible for the special programs and services provided by the United States to Indians because of their status as Indians. (See Section 4 of the “Indian Self-Determination and Education Assistance Act of 1975.”)

Foster Family Home Placements. In accordance with Section 472(c)(1) of the Act “foster family home” placements must meet specified requirements applicable to the period for which title IV-E foster care maintenance payments are being made. These requirements and their effective dates are as follows:

1. Periods starting no earlier than October 1, 2019

The following definition became effective as of October 1, 2019. However, if a title IV-E agency has elected a delayed effective date of up to two years for Section 472(k) of the Act, this definition becomes effective at the expiration of that delay period.

A foster family home includes only the home of an individual or family that meets requirements as follows:

• Is licensed or approved by the title IV-E agency in the State in which it is situated as a foster family home.

• Is licensed or approved by a Tribal authority with respect to a foster family home on or near an Indian Reservation, or a Tribal authority of a Tribal title IV-E agency with respect to a foster family home in the Tribal title IV-E agency's service area.

• Meets the standards established for the licensing or approval.

• Provide care for not more than six children in foster care. This limitation may be exceeded, at the option of the title IV-E agency as requested, for any of the reasons specified at Section 472(c)(1)(B)(i-iv) of the Act.

• The individual(s) in whose care a child has been placed in foster care reside in the home with the child and the title IV-E agency has determined such individual(s)as being:

  • Licensed or approved to be a foster parent; and

  • Deemed capable of adhering to the reasonable and prudent parent standard

  • Providing 24-hour substitute care for children placed away from their parents or other caretakers

Since the definition of a “foster family home” requires that it is the home of an individual or family and that the foster parent resides in the home with the child (section 472(c)(1)(A)(ii) of the Act), the term may not include “group homes, agency-operated boarding homes or other facilities licensed or approved for the purpose of providing foster care…” as previously permitted in the regulatory definition at 45 CFR 1355.20(a) if that facility is not the home of an individual or family where the foster parent resides.

Foster family homes that are approved must be held to the same standards as foster family homes that are licensed. Anything less than full licensure or approval is insufficient for meeting title IV-E eligibility requirements. Title IV-E agencies may, however, claim title IV-E reimbursement during the period of time between the date a prospective foster family home satisfies all requirements for licensure or approval and the date the actual license is issued, not to exceed 60 days.

For purposes of title IV-E claiming (including next quarter estimates) on behalf of a child placed in a foster family home, only those foster care maintenance payments covering allowable costs provided in a home determined to meet this definition may be reported under this funding subcategory.

2. Periods ended no later than September 30, 2019 unless a delayed effective date is applicable

The following definition is in effect for periods through September 30, 2019. However, if a title IV-E agency has elected a delayed effective date of up to two years for Section 472(k) of the Act, this definition remains effective through the expiration of that delay period.

A foster family home is defined in accordance with federal regulations at 45 CFR 1355.20(a) as follows:

The home of an individual or family licensed or approved as meeting the standards established by the licensing or approval authority(ies) that provides 24-hour out-of-home care for children. The licensing authority must be a State authority in the State in which the foster family home is located, a Tribal authority with respect to a foster family home on or near an Indian Reservation or a Tribal authority of a Tribal title IV-E agency with respect to a foster family home in the Tribal title IV-E agency's service area. The term may include group homes, agency-operated boarding homes or other facilities licensed or approved for the purpose of providing foster care by the State or Tribal agency responsible for approval or licensing of such facilities. Foster family homes that are approved must be held to the same standards as foster family homes that are licensed. Anything less than full licensure or approval is insufficient for meeting title IV-E eligibility requirements. Title IV-E agencies may, however, claim title IV-E reimbursement during the period of time between the date a prospective foster family home satisfies all requirements for licensure or approval and the date the actual license is issued, not to exceed 60 days.

Child Care Institutions. In accordance with Section 472(c)(2)(A) a “child care institution” means a private child-care institution, or a public child-care institution which accommodates no more than 25 children, which is appropriately licensed or approved as meeting the standards established for such licensing. For a youth who has attained 18 years of age, the term also includes a supervised setting in which the individual is living independently. Additionally, group homes, agency-operated boarding homes or other facilities licensed or approved for the purpose of providing foster care that otherwise meet the definition of a child care institution and are not the home of an individual or family where the foster parent resides with the child may be included in this term. The term does not include detention facilities, forestry camps, training schools, or any other facility operated primarily for the detention of children who are determined to be delinquent. It also excludes substance abuse treatment facility placements (see definition below).

For purposes of claiming title IV-E foster care maintenance payments (including next quarter estimates) on behalf of an otherwise eligible child placed in a child care institution, limitations may be applicable for such placements made on or after October 1, 2019 (or the elected delayed effective date) if other applicable requirements are not met (see Specified Setting and Non-Specified Setting Child Care Institution Placements definitions below). Title IV-E agencies may, however, claim otherwise allowable administrative costs for an eligible child’s placed in a child care institution regardless of whether the facility meets the requirements described in section 472(k)(1) of the Act.

Specified Setting Child Care Institution Placements. In accordance with Section 472(k) of the Act child care institutions defined as a “specified setting” include only those as follows:

• A qualified residential treatment program as defined in Section 472(k)(4).

• A setting specializing in providing prenatal, post-partum, or parenting supports for youth.

• In the case of a child who has attained 18 years of age, a supervised setting in which the child is living independently.

• A setting providing high-quality residential care and supportive services to children and youth who have been found to be, or are at risk of becoming, sex trafficking victims, in accordance with section 471(a)(9)(C).

For purposes of title IV-E claiming (including next quarter estimates) on behalf of an otherwise eligible child placed in a child care institution, only those foster care maintenance payments for allowable costs provided in a facility determined to meet the specified setting definition as well as other applicable requirements for qualified residential treatment program placements may be reported under this funding subcategory. This definition became effective for placements made as of October 1, 2019. If a title IV-E agency has elected a delayed effective date of up to two years for Section 472(k) of the Act, this definition becomes effective for placements made at the expiration of that delay period.

Non-Specified Setting Child Care Institution Placements. Child care institutions defined as a “non-specified setting” include all child care institutions except those determined to qualify as a “specified setting”. It does not include placements in a licensed residential family-based substance abuse treatment facility consistent with Section 472(j) of the Act since such a facility does not meet the definition of a child care institution.

For purposes of title IV-E claiming (including next quarter estimates) on behalf of a child placed in a child care institution, report under the non-specified setting subcategory any foster care maintenance payments covering allowable costs provided in a facility that does not meet the definition of a specified setting. Prior to the October 1, 2019 effective date of the “specified setting” definition (or a later date if a delayed effective date is requested), title IV-E agencies should report all title IV-E foster care maintenance payments for child care institution placements under this funding subcategory. During this period an option is also available to consolidate the reporting of foster care maintenance payments for foster family homes and child care institutions. See the Part 1, Line 1a instruction for details.

Qualified Residential Treatment Program. A qualified residential treatment program (QRTP) is a type of child care institution within the specified setting designation (see Specified Setting Child Care Institution Placements definition). It consists of a program that has a trauma-informed treatment model that is designed to address the needs, including clinical needs as appropriate, of children with serious emotional or behavioral disorders or disturbances. See Section 472(k)(4) of the Act for information on other requirements.

For purposes of claiming title IV-E foster care maintenance payments (including next quarter estimates) on behalf of a child placed in a QRTP on or after the effective date for the limitations on title IV-E payments for child care institution placement payments (Section 472(k) of the Act), an assessment to determine the appropriateness of such placement must be completed by a “qualified individual” within 30 days after the placement as per Section 475A(c)(1) of the Act. If this deadline is not met, no foster care maintenance payments may be claimed for the duration of the placement (including those for the first two weeks of care) on behalf of the child. A court determination on the appropriateness of this placement must also be made within 60 days of the start of each such placement. If this deadline is not met, foster care maintenance payments on behalf of the child may be title IV-E claimed for only the first 60 days of the placement.

Additionally, if the required assessment determines that the placement of a child in a QRTP is not appropriate, a court disapproves such a placement under Section 475A(c)(2) of the Act, or other circumstances exist where the child is transitioning from a QRTP placement to another setting further title IV-E claiming is limited. As per Section 472(k)(3)(B) of the Act, foster care maintenance payments may be claimed for the period necessary to transition, up to 30 days after the assessment required under section 475A(c)(1) of the Act determines that the QRTP is not appropriate; a court disapproves such a placement under section 475A(c)(2); or a determination is made that a child in an approved QRTP placement is going to return home or be placed with a fit and willing relative, a legal guardian, or an adoptive parent, or in a foster family home.

Substance Abuse Treatment Facility Placements. Children who are placed with a parent receiving care in a licensed residential family-based substance abuse treatment facility may be eligible for title IV-E foster care maintenance payments for up to a 12 month period if specified requirements in Sections 472(j) and 472(a)(2)(C) of the Act are met. The child must be in foster care (under the care and placement responsibility of the title IV-E agency) and meet all the title IV-E foster care eligibility requirements except the AFDC eligibility requirements in Sections 472(a)(1)(B) and (3) of the Act. In-placement administrative costs and training costs attributable to children in substance abuse treatment facility placements are also limited to the same up to 12-month period during which the child is determined as title IV-E eligible. Any costs for treatment of the parent or administration and operation of the substance abuse treatment facility are not title IV-E allowable for any period.

For purposes of claiming title IV-E foster care maintenance payments (including next quarter estimates) on behalf of a child placed with a parent in a licensed residential family-based substance abuse treatment facility, the recommendation for such placement must be specified in the child's case plan before the placement and the treatment facility must meet the requirements at Section 472(j)(1)(B&C) of the Act. A licensed residential family-based treatment facility for substance abuse is not a child care institution as defined in section 472(c) of the Act. While the facility must be licensed, there is no requirement that it meet the title IV-E licensing and background check requirements for a child care institution.

This definition became effective for new or existing placements as of October 1, 2018 and covers, for a period of not more than 12 months, title IV-E foster care maintenance payments meeting the definition as specified at Section 475(4)(A) of the Act, which includes such things as the cost of providing food, clothing, shelter, and daily supervision for the child. The title IV-E agency may not include the costs of administration and operation of the facility since such costs are only title IV-E allowable where provided in a child care institution.

Foster Care (In-Placement). Children are considered to be “in-placement” in a foster care setting where 24-hour substitute care is provided for children placed away from their parents or guardians and for whom the title IV-E agency has placement and care responsibility. This includes, but is not limited to, placements in foster family homes, foster homes of relatives, group homes, emergency shelters, residential facilities, child care institutions, licensed residential family-based substance abuse treatment facilities (child placed with a parent for up to 12 months) and pre-adoptive homes. A child is in foster care in accordance with this definition regardless of whether the foster care facility is licensed and payments are made by the State/Tribal or local agency for the care of the child; whether adoption subsidy payments are being made prior to the finalization of an adoption; or whether there is Federal funding of any payments that are made.

Title IV-E Foster Care Candidates (Pre-Placement). A child is considered to be a candidate and in a “pre-placement” status when determined by the title IV-E agency to be at imminent risk of removal from home and potentially eligible for title IV-E program benefits (section 472(i)(2) of the Act). Foster care candidate status is evidenced by the agency either pursuing the child’s removal from the home or making reasonable efforts to prevent such removal and a decision that the out of home placement for the child will be a foster care setting. Appropriate documentation supporting this determination through one of three acceptable forms to establish a child’s candidacy for title IV-E Foster Care program purposes as prescribed in Departmental policy (see section 8.1D, Question #1 the ACF Children’s Bureau Child Welfare Policy Manual) must be maintained and the title IV-E agency must make a determination (or redetermination) as to whether the child remains at imminent risk of removal from the home at least every 6 months. A child may not be simultaneously both in foster care placement and a candidate for foster care. The determination of those children who are candidates for title IV-E foster care must be made either through individual child determinations or through use of an allocation method for determining potential title IV-E eligibility such as application of a title IV-E foster care participation rate.

Title IV-E funding is available for administrative case management type services through the title IV-E candidate administration funding category on behalf of children determined as title IV-E foster care candidates.

It should be noted that the definition of “title IV-E foster care candidate (pre-placement)” is distinct from the designation of a child as a “candidate for foster care” for the Title IV-E Prevention Services program as is defined below. For example, a title IV-E foster care candidate (pre-placement) must satisfy applicable Title IV-E Foster Care program eligibility requirements and is subject to a re-determination of title IV-E candidate status every six months. There are no such requirements for a candidate for foster care under the Title IV-E Prevention Services program. Separate definitions and instructions for claiming costs under the Title IV-E Prevention Services program are provided below. Title IV-E administrative cost claims may not be made on behalf of a child under both programs simultaneously.

S/TACWIS. In accordance with federal regulations at 45 CFR 1355.51 a statewide automated child welfare information system (SACWIS) or a tribalwide automated child welfare information system (TACWIS) which are collectively referenced as a S/TACWIS means an active automated data processing system or project that ACF had classified as a S/TACWIS on or before July 31, 2016 and:

(i) ACF approved a procurement to develop a S/TACWIS; or

(ii) The applicable state or tribal agency approved a development procurement for a S/TACWIS below the thresholds of 45 CFR 95.611(a).

S/TACWIS has been replaced by the comprehensive child welfare information system (CCWIS) final rule (see CCWIS definition below) and is, therefore, no longer an option for financial reporting purposes. However, prior quarter adjustment claims may be made for eligible S/TACWIS related project expenditures in accordance with CCWIS line item reporting instructions.

CCWIS. In accordance with federal regulations at 45 CFR 1355.51 a comprehensive child welfare information system (CCWIS) is an automated data processing system or project meeting all project requirements in § 1355.52 and the design requirements in § 1355.53. The CCWIS regulations became effective as of August 1, 2016 and replaced the former S/TACWIS regulations. States or tribes may elect to build a new CCWIS on or after August 1, 2016 or transition an existing automated data processing system to a CCWIS during a two year transition period that ran through July 31, 2018. SACWIS operational cost expenditures covered by an approved PACAP may be claimed for periods through September 30, 2018.

CCWIS Cost Allocation. CCWIS regulations allow agencies to allocate some costs benefiting other child welfare related programs and services to the title IV-E program. Both CCWIS development and operational cost allocation rules permit agencies to allocate most CCWIS eligible costs benefiting both title IV-E and non-title IV-E foster care, adoption assistance, and guardianship children to the title IV-E Foster Care program. CCWIS eligible costs benefitting the title IV-E Prevention Services, Kinship Navigator and Chafee programs may also be allocable to the title IV-E Foster Care program. CCWIS development cost allocation rules also permit agencies to allocate additional title IV-B program costs and certain child welfare program-related costs to title IV-E. Only those systems that ACF has classified as CCWIS may qualify for CCWIS cost allocation as per federal regulations at 45 CFR 1355.57. Additionally, for CCWIS designated systems, only costs for those automated functions meeting certain requirements may qualify for CCWIS cost allocation as per 45 CFR 1355.57(a) and (b), Agencies are required to annually submit an updated CCWIS Checklist identifying project activities that may qualify for CCWIS cost allocation meeting the requirements of 45 CFR 1355.52(i)(2). More information on determining which automated functions in a CCWIS system may qualify for CCWIS cost allocation is available through Technical Bulletin #5: CCWIS Cost Allocation dated 11/28/2018.

Non-CCWIS. A non-comprehensive child welfare information system (non-CCWIS) is a child welfare information system that:

1) supports the administration of the title IV-B or IV-E plans, and;

2) does not meet the requirements of federal regulations at 45 CFR 1355.52 or 45 CFR 1355.53 or both.

A child welfare information system also must meet the submission requirements of 45 CFR 1355.52(i) before ACF will classify it as a CCWIS. If the child welfare information system has not been classified as a CCWIS by ACF, it is a non-CCWIS. The term “non-CCWIS” does not include information systems that do not directly support child welfare program activities such as human resource systems, payroll systems, and inventory management systems.

Demonstration Project Costs. These include amounts for performance of project development, evaluation or operations that are chargeable or allocable to a title IV-E demonstration project which has been approved under Section 1130 of the Act and are in accordance with the approved terms and conditions for that project. Demonstration project costs are reported in Part 3 and the fundable totals are then summarized on the appropriate line (by applicable program) in Part 1.

Post-Demonstration Costs. - These include title IV-E foster care allowable amounts for applicable periods in FFYs 2020 or 2021 for performance of activities that would have been classified as within project operations chargeable or allocable to a former title IV-E foster care demonstration project which was operational on September 30, 2019 in accordance with Section 1130 of the Act and with the approved terms and conditions for that project. All post-demonstration costs must be title IV-E allowable without consideration of any waivers that were formerly in effect as per the terms and conditions (in effect on August 30, 2019) of a demonstration project. Post-demonstration costs are identified separately from other title IV-E Foster Care costs to permit an assessment of the availability of Funding Certainty Grants (see Part 3 definition). The costs are reported in Part 3, section E and the totals are summarized on Line 16b in Part 1.

Title IV-E Prevention Services Program – Eligible Participants. The categories of Individuals eligible to receive services through the title IV-E Prevention Services Program include those as follows:

• A child determined by the title IV-E agency as a “candidate for foster care” (Section 475(13) of the Act as defined below).

• A child in foster care who is a pregnant or parenting foster youth (Section 471(e)(2)(B) of the Act).

• Parents or kin caregivers of the children listed above (section 471(e)(1) of the Act).

• Claims for allowable services, administration and training on behalf or eligible participants may be made through the Title IV-E Prevention Services program during a 12-month service period.

Title IV-E Prevention Services Program - Candidates for Foster Care. A child is considered to be a candidate for foster care for purposes of the Title IV-E Prevention Services Program when determined by the title IV-E agency through a prevention plan (Section 471(e)(4)(A)(i) of the Act) as follows:

• Identified in a prevention plan as being at imminent risk of entering foster care (without regard to whether the child would be eligible for title IV-E foster care, adoption assistance or kinship guardianship assistance).

• Has not yet obtained age 18 (see exception for adoption or guardianship arrangements listed below) and also meets this age requirement during the up to 12 consecutive month service period.

• One who must be in need of services qualifying as title IV-E prevention services to prevent removal.

• Who can remain safely in his/her home or in a non-foster care kinship placement as long as services or programs specified in Section 471(e)(1) of the Act that are necessary to prevent the entry of the child into foster care are provided.

• A child who is an otherwise eligible candidate for foster care over age 18, could be eligible for the title IV-E prevention program if:

  • a title IV-E adoption assistance or guardianship assistance agreement is in effect with respect to the child (that went into effect after the child attained 16 years of age);

  • the child’s adoption or guardianship arrangement is at risk of a disruption or dissolution that would result in a foster care placement (section 475(13) of the Act);

  • the child meets the title IV-E agency’s education/employment conditions as elected under title IV-E; and

  • the child has not yet reached the state’s highest elected age under title IV-E (19, 20 or 21).

Note: The last two above sub-bullets also apply to an otherwise eligible pregnant or parenting youth in foster care over age 18.

A candidate for foster care may not include a child in foster care as defined in federal regulations at 45 CFR 1355.20. Therefore, once a child enters foster care, a new or continuing designation of that child as a candidate for foster care ceases along with any reimbursement for costs under the Title IV-E Prevention Services Program.

Title IV-E Prevention Services Program – Eligible Prevention Services and Programs. All prevention services and programs provided through the Title IV-E Prevention Services Program must meet the service and practice requirements outlined in Section 471(e)(1) of the Act as described below. Allowable services include mental health and substance abuse prevention and treatment services provided by a qualified clinician or in-home parent skill-based programs that include parenting skills training, parent education, and individual and family counseling. The allowable services and programs are limited to provision for not more than a 12-month period that begins on the date the child is identified in a prevention plan as either a candidate for foster care or as a pregnant or a parenting foster youth in need of the above specified services or programs. Service provision costs may continue on behalf of that child until the last day of the 12th month if services were provided for the entire 12-month period, or the end of the month in which the child’s title IV-E prevention services ended, whichever is sooner.

Title IV-E Prevention Services Program – Prevention Services and Programs Practice Standards. All eligible prevention services and programs provided by state title IV-E agencies (including under a Tribal-State title IV-E agreement) through the Title IV-E Prevention Services Program must meet the practice standard criteria as specified in Section 471(e)(4)(C) of the Act. Specifically, the services and programs must be performed under a trauma-informed framework, meet general practice requirements and also meet the requirements for being a promising, supported, or well-supported practice in accordance with Section 471(e)(4)((B) and (C) of the Act. In accordance with the Public Law (P.L.) 116-94 Family First Transition Act (within Section 602, Subtitle F, Title I, Division N of the Further Consolidated Appropriations Act, 2020, enacted December 20, 2019), special practice criteria expenditure percentage requirements are in effect for periods in FFYs 2020 through 2023. See Part 1, section D, General Guidance instructions for further details. Beginning in FFY 2024, at least 50 percent of the expenditures for provision of prevention services and programs in each FFY must be for those that meet the “well-supported” practice criteria in accordance with Section 474(a)(6)(A)(ii) of the Act. Further guidance regarding the practice criteria required for services or programs to satisfy these standards will be issued separately by the Children’s Bureau.

Tribal title IV-E agencies (those directly administering title IV-E programs) are not subject to the requirement for states that at least 50 percent of the amounts expended for the provision of programs and services through the Title IV-E Prevention Services program must meet the well-supported practice criteria. Tribal title IV-E agencies may determine the practice criteria for family services and programs that are adapted to the culture and context of the tribal communities served and must describe the practice criteria in their five-year title IV-E prevention program plan.

Part 1 Report Heading Information

Enter the name of the State or Tribe.

Enter the reporting periods, including the ended date of the current (claiming) quarter and the ending date of the next (estimating) quarter.

Enter the report type. Check the box to indicate whether this is a new report (first submission for that quarter) or a revision of a report previously submitted for the same quarter.

SECTION A: FOSTER CARE

General Guidance

Maintenance Assistance Payments

All entries must be a “net” amount; reduced by any income specifically attributable to these payments (e.g. returned checks, overpayment refunds. etc.). Amounts must be reported in consideration of how the service was delivered (i.e., directly by the title IV-E agency vs. through a Tribal-State title IV-E agreement) and by the placement setting category (e.g., family foster home, various child care institution settings, etc.).

Additional guidance applicable to multiple lines is as follows:

• Lines 1a - 1e: Amounts entered are those payments made directly by the title IV-E agency to a foster care provider or to a pass-through organization that does not include those operating under a Tribal-State title IV-E agreement. The Federal share of payments (Columns B, D and F) is computed using the applicable FMAP rate for the State or Tribe. Payments are to be broken out by the child’s placement setting category as specified for each line. Title IV-E maintenance assistance payments reportable as prior quarter adjustments for applicable periods in FFY 2019 or earlier FFYs on behalf of children participating in a formerly operational title IV-E Foster Care demonstration project are reported in Part 3 (sections A and B) of this form to the extent that this funding category is considered in computing cost neutrality for the project and the children are within the project’s target population (see approved project terms and conditions). Additionally, payments made as current quarter and prior quarter adjustments for applicable periods in FFY 2020 and FFY 2021 (including next quarter estimates associated with those current quarter reports) where the involved children and payments was considered in computing the former title IV-E Foster Care demonstration project’s cost neutrality limit must be reported as post-demonstration costs in Part 3 (section E) if the title IV-E agency has applied for consideration for a Funding Certainty Grant (see Part 3 instructions for details). Payments reportable on Line 1d, however, must be reported on that line regardless of the operation of a title IV-E Foster Care demonstration project or the need to report post-demonstration costs. See the Line 1d instruction below for more details.

• Lines 2a – 2c: Amounts entered are those payments made by the State title IV-E agency in accordance with the terms of Tribal-State title IV-E agreements with one or more Federally-recognized Tribes. Payments made in accordance with any other title IV-E agreements (such as with another State agency) are to be reported on Lines 1a – 1e. The Federal share of these payments (Columns B, D and F) is computed using either the State or Tribal FMAP rate, whichever is higher. If the State has multiple agreements with multiple Tribes, this computation is performed separately for the payments made on behalf of each Tribe. Payments are to be broken out by the child’s placement setting category as specified for each line. If a State title IV-E agency was operating a title IV-E Foster Care demonstration project or reporting post-demonstration costs, children served through a Tribal-State title IV-E agreement are treated for financial reporting purposes as outside of the project unless specifically identified as included in the approved project terms and conditions.

Administrative Costs

Expenditures for administrative activities allocable to the title IV-E Foster Care Program must be in accordance with an approved or pending public assistance cost allocation plan under Federal regulations at 45 CFR Part 95, Subpart E – Cost Allocation Plans (States) or an approved child welfare cost allocation methodology and a negotiated indirect cost rate (Tribes).

Expenditures reported on administrative cost lines must be the net amount after being offset by the total amount of any income that may result from the operation of the program (e.g., fees charged for the conduct of out-of-state requested home studies).

Any title IV-E Foster Care administrative costs for applicable periods in FFY 2019 or earlier FFYs incurred on behalf of children participating in a formerly operational title IV-E Foster Care demonstration project are reported in Part 3 (sections A and B) of this form (rather than on these lines) to the extent that this funding category is considered in computing cost neutrality for the project and the children are within the project’s target population (see approved project terms and conditions). Additionally, costs paid in applicable periods in FFY 2020 and FFY 2021 where the involved children and administrative cost funding category was considered in computing the former title IV-E Foster Care demonstration project’s cost neutrality limit must be reported as post-demonstration costs in Part 3 (section E) if the title IV-E agency has applied for consideration for a Funding Certainty Grant (see Part 3 instructions for details).

Information Technology Costs

Lines 11a through 14b cover reporting of all information technology costs directly allocable to a title IV-E program subject to Form CB-496 reporting. These costs include performance of developmental and operational activities and item purchases for CCWIS and non-CCWIS projects as well as prior quarter adjustments for CCWIS, non-CCWIS, S/TACWIS and non-S/TACWIS projects.

Non-CCWIS project costs allocable to title IV-E Foster Care are now separately reported (Lines 11a and 11b) by whether the amount is for operational or developmental costs rather than (under prior Form CB-496 instructions) as part of In-Placement Administrative Costs – Agency Management total reported on former Line 8.

All CCWIS costs (Lines 12a through 14b) must be separately reported based on the developmental or operational classification of the costs, whether or not a CCWIS cost allocation approach is used and whether an Advanced Planning Document (APD) is required as per 45 CFR 95.611. If an approved APD is applicable, CCWIS amounts must also be separated by the project number as assigned by the Children’s Bureau.

Automated systems previously classified as a S/TACWIS project, include project numbers starting with 1 or 2. States or tribes submitting prior quarter adjustments for such pre-CCWIS projects should use the S/TACWIS project number on the appropriate CCWIS reporting line. Many former S/TACWIS projects were ‘transitioned’ to a CCWIS project and maintained the same project number when the system was reclassified as a CCWIS. Prior quarter adjustments for former non-S/TACWIS projects may be reported on the appropriate non-CCWIS line (Line 11a or Line 11b).

Line by Line Instructions

Line 1a. Agency Maintenance Assistance Payments - Foster Family Home (FMAP Rate). Enter the payments, as defined in Section 475(4)(A) of the Act, made by the title IV-E agency on behalf of children determined to be eligible for Foster Care services under title IV-E and placed in a Foster Family Home as defined in Section 472(c)(1) of the Act. For periods prior to the title IV-E agency’s implementation of limitations on title IV-E foster care maintenance payments for placements that are not foster family homes (Section 472(k) of the Act), a title IV-E agency may also use this line to report payments made by the agency on behalf of eligible children placed in child care institutions that would otherwise be reportable on lines 1b or 1c. After October 1, 2019 (or the title IV-E agency’s delayed effective date for implementing the limitations on title IV-E maintenance payments for placements that are not foster family homes), the agency must report payments for children placed in child care institutions on line 1b or 1c, as described below. Title IV-E foster care maintenance payments reportable on Line 1d must be reported on that line for all periods beginning on or after October 1, 2018.

(Enter this amount directly on this form.)

Line 1b. Agency Maintenance Assistance Payments – Specified Setting Child Care Institution (FMAP Rate). Enter the payments, as defined in Section 475(4)(A) of the Act, made by the title IV-E agency on behalf of children determined to be eligible for Foster Care services under title IV-E and placed in a Specified Setting Child Care Institution as defined in Sections 472(c)(2) and 472(k)(2) of the Act. Additional requirements for title IV-E reimbursement apply to those Specified Setting Child Care Institutions consisting of a Qualified Residential Treatment Program placement as per Sections 472(k)(3) and (4). Payments reported on this line cannot begin earlier than the effective date (including any election of a delayed effective date) of the title IV-E agency’s title IV-E Plan amendment to implement Section 472(k) of the Act.

(Enter this amount directly on this form.)

Line 1c. Agency Maintenance Assistance Payments – Non-Specified Setting Child Care Institution (FMAP Rate). Enter the payments, as defined in Section 475(4)(A) of the Act, made by the title IV-E agency on behalf of children determined to be eligible for Foster Care services under title IV-E and placed in a Child Care Institution as defined in Section 472(c)(2) of the Act that does not meet the specified setting requirements at Section 472(k)(2) of the Act. Such payments are generally limited to covering a two-week period for each placement. Payments for any continuous child care institution placements with a start date prior to the effective date for Section 472(k)(2) of the Act are not time limited but must also be reported on this line. For periods prior to the effective date of Section 472(k)(2) of the Act, or for title IV-E agencies that have elected a delayed effective date for this provision, maintenance assistance payments made for placements in a child care institution during the non-effective or delay period (without application of the two-week period limit) are treated as for “non-specified setting” placements and are thus to be reported on this line. During this period an option is also available to consolidate the reporting of foster care maintenance payments for foster family homes and child care institutions. See the Part 1, Line 1a instruction for details.

(Enter this amount directly on this form.)

Line 1d. Agency Maintenance Assistance Payments – Substance Abuse Treatment Facility (FMAP Rate). Enter the payments, as defined in Section 475(4)(A) of the Act, made by the title IV-E agency for periods beginning in FFY 2019 on behalf of children determined to be eligible for Foster Care services under title IV-E or who would be eligible for the payments in all respects except for the AFDC eligibility requirements (paragraphs (1)(B) and (3) of Section 472(a) of the Act), and placed with a parent residing in a licensed residential family-based treatment facility for substance abuse as defined in Section 472(j) of the Act. Such payments are limited to a period of not more than 12 months and may not include any costs for treatment of the parent or administration and operation of the treatment facility since a licensed residential family-based treatment facility for substance abuse is not a child care institution as defined in Section 472(c) of the Act. Any title IV-E allowable administrative or training costs (reportable on other lines in this Part) associated with these payments is also limited to the same 12 month period as provided for maintenance assistance payments.

State and tribal agencies that operated a title IV-E foster care demonstration project or are reporting post-demonstration costs should note that expenditures for the payments described as reportable on this line are maintenance assistance costs outside of those described in the approved terms and conditions for the project as subject to the applicable cost neutrality limit and must, therefore, be reported on Line 1d rather than in Part 3.

(Enter this amount directly on this form.)

Line 1e. Agency Maintenance Assistance Payments – Total (FMAP Rate). This line represents the total amount of title IV-E Foster Care maintenance assistance payments made by the title IV-E agency through direct (other than Tribal-State title IV-E agreements) program operations.

(Calculated as the sum of Lines 1a through 1d.)

Line 2a. Tribal-State Title IV-E Agreement Maintenance Assistance Payments - Foster Family Home (at the applicable FMAP Rate).

o TRIBES: Leave this line blank.

o STATES: This line is applicable only to States that have title IV-E agreements with Tribes.

Enter the payments, as defined in Section 475(4)(A) of the Act, made through Tribal-State title IV-E agreements on behalf of children determined to be eligible for Foster Care services under title IV-E and placed in a Foster Family Home as defined in Section 472(c)(1) of the Act. For periods prior to the title IV-E agency’s implementation of limitations on title IV-E foster care maintenance payments for placements that are not foster family homes (Section 472(k) of the Act), a title IV-E agency may also use this line to report payments made by the agency through Tribal-State title IV-E agreements on behalf of eligible children placed in child care institutions that would otherwise be reportable on line 2b. After October 1, 2019 (or the title IV-E agency’s delayed effective date for implementing the limitations on title IV-E maintenance payments for placements that are not foster family homes), the agency must report payments for children placed in child care institutions on line 2b, as described below. Title IV-E foster care maintenance payments reportable on Line 2b on behalf of a child placed with a parent residing in a licensed residential family-based treatment facility for substance abuse must be reported on that line for all periods beginning on or after October 1, 2018.

If the State does not have a title IV-E agreement with any Federally-recognized Tribe, no entries should be made on this line.

(Enter this amount directly on this form.)

Line 2b. Tribal-State Title IV-E Agreement Maintenance Assistance Payments – Other Qualifying Placements (at the applicable FMAP Rate).

o TRIBES: Leave this line blank.

o STATES: This line is applicable only to States that have title IV-E agreements with Tribes.

Enter the payments, as defined in Section 475(4)(A) of the Act, made through Tribal-State title IV-E agreements on behalf of children determined to be eligible for Foster Care services under title IV-E and placed in a facility meeting title IV-E Foster Care maintenance payment requirements other than a family foster home. Such facilities include a Child Care Institution as defined in Section 472(c)(2) of the Act or where an eligible child is placed with a parent residing in a licensed residential family-based treatment facility for substance abuse (payments limited to a period of not more than 12 months and may not include any costs for treatment of the parent or administration and operation of the treatment facility) in accordance with Section 472(j) of the Act. Child care institution placements reported on this line include both those meeting the specified setting requirements at Sections 472(k)(2) and 472(j) of the Act as well as those that do not meet such requirements. All reported payments, however, must be title IV-E allowable in accordance with the classification of the child care institution and the applicable statutory provisions.

If the State does not have a title IV-E agreement with any Federally-recognized Tribe, no entries should be made on this line.

(Enter this amount directly on this form.)

Line 2c. Tribal-State Title IV-E Agreement Maintenance Assistance Payments – Total (at the applicable FMAP Rate).

o TRIBES: Leave this line blank.

o STATES: This line is applicable only to States that have title IV-E agreements with Tribes.

This line represents the total amount of title IV-E Foster Care maintenance assistance payments made through Tribal-State title IV-E agreements.

(Calculated as the sum of Lines 2a through 2b.)

Line 3. Federal Share of Child Support Collections. Enter the Federal share of Child Support Collections.

o TRIBES: Leave this line blank.

o STATES: Complete this line.

(The Current Quarter amount in Column B is carried from the amount calculated on Line 10a, Column G, of Form OCSE-34, the “Child Support Enforcement Program Quarterly Collection Report”)

The Next Quarter Estimate in Column F is determined based on historical trends

Note: Amounts entered on this line must include child support collections on behalf of title IV-E eligible children on whose behalf maintenance assistance payments have been reported in either Part 1 or Part 3 of this form.

Line 4. Net Maintenance Assistance Payments. This line represents the net amount of assistance payments being claimed and estimated for Federal funding in Columns B, D and F, respectively.

(Calculated as the sum of Lines 1e and 2c minus Line 3)

Line 5. In-Placement Administrative Costs - Case Planning and Management. Enter the amount expended for title IV-E eligible children in a Foster Care placement for the development, review or revision of case plans or the supervision or management of cases. Case planning activities largely comport with the “case plan” and “case review system” requirements as defined in Section 475(1) and (5), respectively, of the Act. Examples of activities included within case management are referral to services, agency preparation for and participation in judicial proceedings, placement of the child and accessing the Federal Parent Locator Service (FPLS) to search for relatives. Legal costs in representing the agency in foster care judicial determinations are to be reported on this line. However, any allowable legal costs for an independent attorney representing a child or the child’s parent(s) are to be reported separately below on Line 8 (if the child is in-placement) or on Line 10b (if the child is a title IV-E foster care candidate). Any directly allocable child welfare automated system costs associated with performing these activities must not be reported on this line. Those costs, whether associated with a CCWIS or a non-CCWIS project, should be reported on Lines 11a – 14b, as appropriate. It should also be noted that costs incurred for case management activities on behalf of children not in foster care but determined as candidates for title IV-E Foster Care or as candidates for foster care as part of the title IV-E Prevention Services program must be reported separately on Line9 or Line 40, respectively.

(Enter this amount directly on this form.)

Line 6. In-Placement Administrative Costs - Eligibility Determination. Enter the amount directly related only to those activities involved in the actual verification and documentation of title IV-E eligibility on behalf of children in a foster care placement. Costs for staff responsible for the determination of eligibility for a number of programs including title IV-E Foster Care must be allocated to the appropriate benefiting program. Activities related to judicial determinations, placement of the child or periodic court or administrative reviews are not a component of eligibility determination costs.

(Enter this amount directly on this form.)

Line 7. In-Placement Administrative Costs - Provider and Agency Management. Enter the amount of expenditures for foster care provider-related and agency management in-placement foster care administrative activities, not included in Lines 5 and 6, whose costs may be directly chargeable or partially allocable to title IV-E Foster Care. Examples of provider management type activities include foster parent recruitment; the licensing/approval of foster homes and child care institutions; the conduct of criminal records and child abuse registry checks of a foster family home or of any adult working in a child care institution; the holding of foster care related fair hearings; and the operation of a rate setting or rate monitoring unit. Examples of agency program management activities potentially associated with the administration of title IV-E Foster Care include: policy development; data collection and reporting (i.e. non-child welfare information systems such as those used for human resource, payroll, and inventory management); financial management (i.e. processing of checks and preparation of claiming schedules); administration associated with the provision of training; operation of a quality assurance system; and a proportionate share of related agency overhead. Any directly allocable child welfare automated system costs must not be reported on this line. Those costs, whether associated with a CCWIS or a non-CCWIS project, should be reported on Lines 11a – 14b, as appropriate, in accordance with the instructions provide for those lines.

(Enter this amount directly on this form.)

Line 8. In-Placement Administrative Costs – Legal Representation – Child or Parent. Enter the amount of expenditures to provide independent legal representation by an attorney for a title IV-E eligible child in foster care or the child's parents to prepare for and participate in all stages of foster care related legal proceedings. Such proceedings involve court hearings related to a child's removal from the home. Legal costs in representing the agency in title IV-E foster care judicial determinations are reported as a component of case planning and management activities on Line 5 above and legal representation costs for title IV-E foster care candidate cases are reported on either Line 10a (agency representation) or Line 10b (child or parent(s) representation).

State and tribal agencies that formerly operated a title IV-E foster care demonstration project should note that expenditures for the activities described as reportable on this line are administrative costs outside of those described in the approved terms and conditions for the project as subject to the applicable cost neutrality limit and must, therefore, be reported on Line 1d rather than in Part 3.

(Enter this amount directly on this form.)

Line 9. Total In-Placement Foster Care Administrative Costs. This line represents the total amount of title IV-E Foster Care (in-placement) administrative expenditures being claimed for Federal funding.

(Calculated as the sum of Lines 5 through 7.)

Line 10a. Title IV-E Foster Care Candidate Administrative Costs - Case Planning and Management. Enter the amount for allowable pre-placement case planning and management activities applicable to individual children who are not in foster care but have been determined as candidates for placement in title IV-E-Foster Care. Such a child must be at imminent risk of removal from home as evidenced by the title IV-E agency either pursuing his/her removal from the home or making reasonable efforts to prevent such removal, and redetermining at least every six months that the child remains at imminent risk of removal from the home. All allowable administrative costs on behalf of “Title IV-E Foster Care Candidates (Pre-Placement)” (see the definitions section) must be reported on this line except for independent legal representation costs that are reported on Line 10b below. This line does not include costs for time-limited prevention programs and services as defined in Sections 471(e), 474(a)(6) and 475(13) of the Act.

If a title IV-E agency has approval to administer the optional Title IV-E Prevention Services Program (for periods no earlier than the beginning of FFY 2020) it should report administrative costs for children who are “Title IV-E Prevention Services Program - Candidates for Foster Care” (see the definitions section) in accordance with prevention program requirements on Lines 45 or 46 in this Part rather than on this line.

(Enter this amount directly on this form.)

Line 10b. Title IV-E Foster Care Candidate Administrative Costs – Legal Representation – Child or Parent. Enter the amount for allowable pre-placement independent legal representation activities applicable to individual children who are not in foster care but have been determined as candidates for placement in title IV-E-Foster Care. Such a child must be at imminent risk of removal from home as evidenced by the title IV-E agency either pursuing his/her removal from the home or making reasonable efforts to prevent such removal, and redetermining at least every six months that the child remains at imminent risk of removal from the home. All allowable administrative costs on behalf of “Title IV-E Foster Care Candidates (Pre-Placement)” (see the definitions section) must be reported on this line or on Line 10a above. This line does not include costs for time-limited prevention programs and services as defined in Sections 471(e), 474(a)(6) and 475(13) of the Act.

State and tribal agencies that formerly operated a title IV-E foster care demonstration project should note that expenditures for the activities described as reportable on this line are administrative costs outside of those described in the approved terms and conditions for the project as subject to the applicable cost neutrality limit and must, therefore, be reported on Line 1d rather than in Part 3.

If a title IV-E agency has approval to administer the optional Title IV-E Prevention Services Program (for periods no earlier than the beginning of FFY 2020) it should report administrative costs for children who are “Title IV-E Prevention Services Program - Candidates for Foster Care” (see the definitions section) in accordance with prevention program requirements on Lines 45 or 46 in this Part rather than on this line.

(Enter this amount directly on this form.)

Line 10c. Sex Trafficking Administrative Costs. Enter the amount of expenditures for allowable sex trafficking administrative costs (see list of allowable activities below) made on behalf of any child or youth in the placement, care or supervision of the title IV-E agency who is at-risk of becoming a sex trafficking victim or who is identified as a sex trafficking victim as per sections 471(a)(9) and (34) of the Act. Such children include those who are not removed from home; those who have run away from foster care and are under age 18 or such higher age elected under section 475(8) of the Act; and youth not in foster care who are receiving services under the Chafee Foster Care Program for Successful Transition to Adulthood and at the option of the agency, youth under age 26 who were or were never in foster care. In addition, allowable expenditures made on behalf of any child missing from foster care for the purpose of administering section 471(a)(35) of the Act are also reported as sex trafficking administrative costs.

Activities for which title IV-E funding is available as sex trafficking administrative costs beginning for periods in federal fiscal year (FFY) 2015 are as follows:

• Developing and implementing policies and procedures to identify, document in agency records, and determine appropriate services for victims of sex trafficking;

• Conducting sex trafficking screenings and documenting victims of sex trafficking in agency files;

• Determining appropriate services for individuals identified as such victims; and

• Completing reports required for law enforcement and ACF of children or youth who the agency identifies as being a sex trafficking victim.

• Developing and implementing protocols to locate and assess children missing from foster care, including screening the child to identify if the child is a possible sex trafficking victim.

Since the title IV-E agency is not limited to performing the activities described above on behalf of individuals meeting title IV-E eligibility requirements, there is no need to apply a title IV-E foster care participation rate in allocating allowable costs to the title IV-E foster care program.

Title IV-E funding is not available for expenditures to conduct investigations of allegations of sex trafficking or other forms of child abuse or neglect or to provide social services to these or other children or youth and must not be reported on this line or elsewhere in this Part. (To the extent authorized under an approved title IV-E demonstration project, any such service expenditures are to be reported in Part 3 and then summarized on line 16). Additionally, foster care administrative costs (both in-placement and candidate) for activities other than those defined above as “sex trafficking administrative costs” or “in-placement administrative costs - eligibility determination” must be cost allocated to assure that title IV-E reported claims and estimates are limited to amounts for only those children determined as title IV-E eligible.

State and tribal agencies operating a title IV-E foster care demonstration project should note that expenditures for the activities described as reportable on this line are administrative costs outside of those described in the approved terms and conditions for the project as subject to the applicable cost neutrality limit and must, therefore, be reported on Line 10b rather than in Part 3.

(Enter this amount directly on this form.)

Line 11a - Non-CCWIS Project Operational Costs. Enter expenditures and estimates allocable to title IV-E Foster Care made for the operation and maintenance of an automated system that is determined to be entirely classified as a non-CCWIS. Non-CCWIS project costs for developmental planning, design, development, implementation or enhancement are reported on Line 11b. Any non-CCWIS operational costs allocable to another title IV-E program must be reported as an administrative cost for the involved program(s) on the appropriate administrative cost reporting line (Lines 22, 31, 40 and 45). All CCWIS project costs, whether or not eligible for CCWIS cost allocation, should be reported on Lines 12a – 14b, as appropriate.

(Enter this amount directly on this form.)

Line 11b - Non-CCWIS Project Developmental Costs. Enter expenditures and estimates allocable to title IV-E Foster Care made for the planning, design, development, implementation or development enhancement (e.g., a change of software or hardware functionality beyond their original purpose) of an automated system or project which is entirely classified as a non-CCWIS regardless of whether an Advance Planning Document (APD) was submitted for the project. Any non-CCWIS developmental costs allocable to another title IV-E program, must be reported as an administrative cost for the involved program(s) on the appropriate administrative cost reporting line (Lines 22, 31, 40 and 45). All CCWIS project costs, whether or not eligible for CCWIS cost allocation, should be reported on Lines 12a – 14b, as appropriate.

(Enter this amount directly on this form.)

Line 12a - CCWIS Project Operational Costs Using CCWIS Cost Allocation. Enter expenditures and estimates allocable to any title IV-E program (including Foster Care) made for operational costs for all CCWIS designated projects where the automated function is eligible for application of the CCWIS cost allocation method as specified at 45 CFR § 1355.57 (see CCWIS Cost Allocation in the definitions section). Any directly allocable automated system operational costs for projects not eligible as a CCWIS must not be reported on this line. Using the dropdown feature, reported costs must be broken out by the associated project number, if applicable, assigned by the Children’s Bureau Division of State Systems as part of the project APD approval process. Any prior quarter adjustments reported on this line must also be reported in Part 2 with the associated project number listed in Column E (Adjustment Identification and Explanation).

__[Provide enterable 2 digit project number] (e.g., NA, 01, 02, 03,…99))

__[Provide enterable 2 digit project number] (e.g., NA, 01, 02, 03,…99))

__[Provide enterable 2 digit project number] (e.g., NA, 01, 02, 03,…99))

(Enter this amount directly on this form.)

Line 12b - CCWIS Project Operational Costs Using Non-CCWIS Cost Allocation. Enter expenditures and estimates allocable to any title IV-E program (including Foster Care) made for operational costs for all CCWIS designated projects where the automated function is not eligible for application of the CCWIS cost allocation method as specified at 45 CFR § 1355.57. Any directly allocable automated system operational costs for projects not eligible as a CCWIS must not be reported on this line. Using the dropdown feature, reported costs must be broken out by the associated project number, if applicable, assigned by the Children’s Bureau Division of State Systems as part of the project APD approval process. Any prior quarter adjustments reported on this line must also be reported in Part 2 with the associated project number listed in Column E (Adjustment Identification and Explanation).

__[Provide enterable 2 digit project number] (e.g., NA, 01, 02, 03,…99))

__[Provide enterable 2 digit project number] (e.g., NA, 01, 02, 03,…99))

__[Provide enterable 2 digit project number] (e.g., NA, 01, 02, 03,…99))

(Enter this amount directly on this form.)

Line 13a - CCWIS Project Developmental Costs Using CCWIS Cost Allocation – APD Required. Enter expenditures and estimates allocable to any title IV-E program (including Foster Care) made for developmental costs for all CCWIS designated projects with an approved APD where the cost is eligible for application of the CCWIS cost allocation method as specified at 45 CFR § 1355.57 (see CCWIS Cost Allocation in the definitions section). Using the dropdown feature, reported costs must be broken out by the associated project number assigned by the Children’s Bureau Division of State Systems as part of the project APD approval process. Any directly allocable automated system developmental costs for projects not eligible as a component of a CCWIS or for CCWIS projects – ADP required where the cost is not eligible for CCWIS cost allocation must not be reported on this line. Any prior quarter adjustments reported on this line must also be reported in Part 2 with the associated project number listed in Column E (Adjustment Identification and Explanation).

__[Provide enterable 2 digit project number] (e.g., 01, 02, 03,…99))

__[Provide enterable 2 digit project number] (e.g., 01, 02, 03,…99))

__[Provide enterable 2 digit project number] (e.g., 01, 02, 03,…99))

(Enter this amount directly on this form.)

Line 13b - CCWIS Project Developmental Costs Using Non-CCWIS Cost Allocation – APD Required. Enter expenditures and estimates allocable to any title IV-E program (including Foster Care) made for developmental costs for all CCWIS designated projects with an approved APD where the cost is not eligible for application of the CCWIS cost allocation method as specified at 45 CFR § 1355.57. Using the dropdown feature, reported costs must be broken out by the associated project number assigned by the Children’s Bureau Division of State Systems as part of the project APD approval process. Any directly allocable automated system developmental costs for projects not eligible as a component of a CCWIS or for CCWIS projects – ADP required where the cost is not eligible for CCWIS cost allocation must not be reported on this line. Any prior quarter adjustments reported on this line must also be reported in Part 2 with the associated project number listed in Column E (Adjustment Identification and Explanation).

__[Provide enterable 2 digit project number] (e.g., 01, 02, 03,…99))

__[Provide enterable 2 digit project number] (e.g., 01, 02, 03,…99))

__[Provide enterable 2 digit project number] (e.g., 01, 02, 03,…99))

(Enter this amount directly on this form.)

Line 14a - CCWIS Project Developmental Costs Using CCWIS Cost Allocation - No APD Required. Enter expenditures and estimates allocable to any title IV-E program (including Foster Care) made for developmental costs for those CCWIS designated projects not subject to the APD approval process where the associated automated function is eligible for application of the CCWIS cost allocation method as specified at 45 CFR § 1355.57 (see CCWIS Cost Allocation in the definitions section). Any directly allocable automated system developmental costs for CCWIS projects with an APD approval and projects not eligible as a component of a CCWIS must not be reported on this line.

[CB DSS will add or delete as needed]

(Enter this amount directly on this form.)

Line 14b - CCWIS Project Developmental Costs Using Non-CCWIS Cost Allocation - No APD Required. Enter expenditures and estimates allocable to any title IV-E program (including Foster Care) made for developmental costs for those CCWIS designated projects not subject to the APD approval process where the associated automated function is not eligible for application of the CCWIS cost allocation method as specified at 45 CFR § 1355.57. Do not report on this line any directly allocable automated system developmental costs for CCWIS projects with an APD approval and projects not eligible as a component of a CCWIS.

(Enter this amount directly on this form.)

Line 15. Training Costs – Staff, Provider and Professional Partner (At the 75 Percent FFP Rate). Enter the allocated amount of expenditures incurred for the development, delivery or participation in training by eligible individuals. (See 45 CFR 235.63 through 235.66(a) and 1356.60(b)(1)). Eligible individuals include title IV-E agency staff and certain others providing care to children in receipt of title IV-E Foster Care.

Short-term training related to title IV-E Foster Care is also available for professional partner participants in accordance with Section 474(a)(3)(B) of the Act as follows:

• Tribe/State-licensed or approved child welfare agency staff providing services to children receiving title IV-E assistance;

• Child abuse and neglect court personnel;

• Agency, child or parent attorneys;

• Guardians ad litem; and;

• Court appointed special advocates.

Professional partner training is eligible for Federal funding at the 75 percent FFP rate for periods beginning with FFY 2013 and thereafter. Federal funding was also available for periods in FFYs 2009 – 2012 at differing FFP rates that increased each year over a five-year “transitional” period (see Section 203(b) of P.L. 110-351).

The topics for all title IV-E training must be closely related to one of the examples of allowable administrative activities cited in 45 CFR 1356.60(c)(1) and (2). All training activities and costs funded under title IV-E shall be included in the title IV-E agency’s training plan for title IV-B.

Do not include:

• Expenditures for the training of ineligible individuals or for training on topics not determined as title IV-E eligible.

• Some costs associated with title IV-E training such as those derived through the application of an indirect cost rate may not qualify as training costs. To the extent that any such amount may be allocable to title IV-E Foster Care and qualify as an allowable administrative cost, it should be reported on Line 7.

• Title IV-E Prevention Services or Kinship Navigator program training to staff and providers. These expenditures, to the extent allocable to title IV-E, are reported in Section D of this Part.

• If the title IV-E agency has an approved and operational title IV-E Foster Care demonstration project in which this funding category is considered in computing cost neutrality for the project, costs must be reported in Part 3 of this form (rather than on this line) to the extent specified in the project’s approved project terms and conditions.

(Enter this amount directly on this form.)

Line 16a. Demonstration Project Costs. Enter amounts for approved title IV-E Foster Care demonstration projects authorized under Section 1130 of the Act as computed on Part 3.

(Enter this amount directly on this form. This amount is carried from the amount calculated on Part 3, Line 25c of this form.)

Line 16b. Post-Demonstration Costs. Enter title IV-E allowable amounts for applicable periods in FFYs 2020 or 2021 for performance of activities that would have been classified as within project operations chargeable or allocable to a title IV-E foster care demonstration project in accordance with Section 1130 of the Act as computed on Part 3 of this form. All costs must be title IV-E allowable without consideration of any waivers that were formerly in effect as per the terms and conditions of a demonstration project.

(Enter this amount directly on this form. This amount is carried from the amount calculated on Part 3, Line 28a of this form.)

Line 17. Total Costs. This line represents the total expenditures being claimed for the current quarter (Columns A and B) and for prior quarters (Columns C and D) and the expenditures being estimated for the next quarter (Columns E and F).

(Calculated as:

Columns A and C: Sum of Lines 1e + 2c + 8 through 16;

Columns B and D: Sum of Lines 4 + 8 through 16;

Column E: Sum of Lines 1e + 2c + 8 through 16; and

Column F: Sum of Lines 4 + 8 through 16.)

Line 18. Non-Federal (State or Tribal) Share of Total Costs. This line represents in Columns B, D and F the Tribal/State share amount of the total reported costs for the current quarter, prior quarter adjustments and for next quarter estimates. These are the funds that the title IV-E agency has expended in the current or a prior quarter or that it is certifying that will be made available, when needed, for the required Tribal/State share of program costs in the next quarter.

For States: Include funds appropriated by the State legislature for these purposes.

For Tribes: Include funds appropriated by the Tribe and certain types and levels of in-kind expenditures (or contributions) by certain third parties, if any. (See instructions for Line 20)

(Calculated as:

Column B = Line 17, Column A minus Line 17, Column B;

Column D = Line 17, Column C minus Line 17, Column D and

Column F = Line 17, Column E minus Line 17, Column F.)

Line 19. Tribal Share of Costs from Third Party In-Kind Sources.

o TRIBES: Complete this line..

o STATES: Leave this line blank. This information is not applicable to States.

Enter in Columns B, D and F the portion of the amount reported on Line 18 derived from third party in-kind expenditures.

Tribes are permitted by statute to use in-kind expenditures from certain third party sources as a portion of their share of administrative and training costs. The option for Tribes to partially utilize in-kind expenditures is available only for certain fiscal years, from certain sources and up to specified limits in accordance with Section 479B(c)(1)(D) of the Act and applicable regulations.

(Enter this amount directly on this form.)

SECTION B: ADOPTION ASSISTANCE

Line by Line Instructions

Line 20. Agency Adoption Assistance Payments (FMAP Rate). Enter the payments made directly by the title IV-E agency in accordance with an Adoption Assistance agreement entered prior to the finalization of the adoption on behalf of children with special needs, as defined in Section 473(c) of the Act, determined eligible under title IV-E in accordance with Section 473(a)(2) of the Act.

Amounts entered on this line are only those payments made directly by the title IV-E agency. Payments made under the terms of a Tribal-State title IV-E agreement are reported separately on Line 21. This must be a “net” amount, reduced by any income specifically attributable to these payments (e.g., returned checks, overpayment refunds etc.).

The Federal share of these payments (as entered in Columns B, D and F) is computed using the applicable FMAP rate for the State or Tribe.

(Enter this amount directly on this form.)

Line 21. Tribal-State Title IV-E Agreement Adoption Assistance Payments (Applicable FMAP Rate).

o TRIBES: Leave this line blank.

o STATES: This line is applicable only to States that have title IV-E agreements with Tribes.

Enter the payments made in accordance with an Adoption Assistance agreement entered prior to the finalization of the adoption on behalf of children with special needs (as defined in Section 473(c) of the Act) determined eligible under title IV-E in accordance with Section 473(a)(2) of the Act.

Amounts entered on this line are only those payments made by the State title IV-E agency in accordance with the terms of Tribal-State title IV-E agreements with one or more Federally-recognized Tribes. This must be a “net” amount, reduced by any income specifically attributable to these payments (e.g., returned checks, overpayment refunds etc.).

The Federal share of these payments (as entered in Columns B, D and F) is computed using either the State or the Tribal FMAP rate, whichever is higher. If the State has multiple agreements with multiple Tribes, this computation is performed separately for the payments made on behalf of each Tribe.

If the State does not have a title IV-E agreement with any Federally-recognized Tribe, no entries should be made on this line.

(Enter this amount directly on this form.)

Line 22. Administrative Costs - Agency. Enter the amount of expenditures for administrative activities allocable to the title IV-E Adoption Assistance Program, in accordance with an approved or pending public assistance cost allocation plan under Federal regulations at 45 CFR Part 95, Subpart E – Cost Allocation Plans (States) or an approved child welfare cost allocation methodology and a negotiated indirect cost rate (Tribes).

Expenditures reported on this line must be a “net” amount, offset by the amount of any income that may result from the operation of the program. (Expenditures for non-recurring administrative costs must be identified separately and reported on Line 23.)

(Enter this amount directly on this form.)

Line 23. Administrative Costs - Non-Recurring. Enter the amount of non-recurring adoption expenses. These are costs incurred in accordance with a title IV-E Adoption Assistance agreement entered into prior to the finalization of the adoption of a child who meets the definition of special needs. (See Section 473 (c) of the Act.) These costs are limited to $2,000 for each adoptive placement or at a lower limit set by the State or Tribe.

The child does not have to be under the responsibility for placement and care of the title IV-E agency in order for the adoptive parents to be reimbursed for the nonrecurring expenses of adoption. In accordance with 45 CFR 1356.41(i), non-recurring costs include the reasonable and necessary adoption fees, court costs, attorney fees and other expenses which are directly related to the legal adoption of a child with special needs, which are not incurred in violation of Tribal, State or Federal law, and which have not been reimbursed from other sources or funds.

(Enter this amount directly on this form.)

Line 24. Training Costs – Staff, Provider and Professional Partner (At the 75 percent FFP Rate). Enter the allocated amount of expenditures incurred for the development, delivery or participation in training by eligible individuals (See 45 CFR 235.63 through 235.66(a) and 1356.60(b)(1)). Eligible individuals include title IV-E agency staff and certain others providing care to children in receipt of title IV-E Adoption Assistance.

Short-term training related to title IV-E Adoption Assistance Care is also available for professional partner participants in accordance with Section 474(a)(3)(B) of the Act as follows:

• Tribe/State-licensed or approved child welfare agency staff providing services to children receiving title IV-E assistance;

• Child abuse and neglect court personnel;

• Agency, child or parent attorneys;

• Guardians ad litem; and

• Court appointed special advocates.

Professional partner training is eligible for Federal funding at the 75 percent FFP rate for periods beginning with FFY 2013 and thereafter. Federal funding was also available for periods in FFYs 2009 – 2012 at differing FFP rates that increased each year over a five-year “transitional” period (see Section 203(b) of P.L. 110-351).

The topics for all title IV-E training must be closely related to one of the examples of allowable administrative activities cited in 45 CFR 1356.60(c)(1) and (2). All training activities and costs funded under title IV-E shall be included in the IV-E agency's training plan for title IV-B.

Do not include:

• Expenditures for the training of ineligible individuals or for training on topics not determined as title IV-E eligible.

• Some costs associated with title IV-E training such as those derived through the application of an indirect cost rate may not qualify as training costs. To the extent that any such amount may be allocable to title IV-E Adoption Assistance and qualify as an allowable administrative cost, it should be reported on Line 22.

(Enter this amount directly on this form.)

Line 25. Demonstration Project Costs. Enter the amount for approved demonstration projects for Adoption Assistance authorized under Section 1130 of the Act as computed on Part 3 of this form.

(This amount is carried from the amount calculated on Part 3, Line 25c of this form.)

Line 26. Total Costs. This line represents the total expenditures being claimed for the current quarter (Columns A and B) and for prior quarters (Columns C and D) and the expenditures being estimated for the next quarter (Columns E and F).

(Calculated as the sum of Lines 20 through 25.)

Line 27. Non-Federal (State or Tribal) Share of Total Costs. This line represents in Columns B, D and F the Tribal/State share amount of total reported costs for the current quarter, prior quarter adjustments and for next quarter estimates. These are the funds that the title IV-E agency has expended in the current or a prior quarter or that it is certifying that will be made available, when needed, for the required Tribal/State share of program costs in the next quarter.

For States: Include funds appropriated by the State legislature for these purposes.

For Tribes: Include funds appropriated by the Tribe and certain types and levels of in-kind expenditures (or contributions) by certain third parties, if any. (See instructions for Line 30)

(Calculated as:

Column B = Line 26, Column A minus Line 26, Column B;

Column D = Line 26, Column C minus Line 26, Column D and

Column F = Line 26, Column E minus Line 26, Column F.)

Line 28. Tribal Share of Costs Claimed/Estimated From Third Party In-Kind Sources.

o TRIBES: Complete this line.

o STATES: Leave this line blank. This information is not applicable to States.

Enter in Columns B, D and F the portion of the amount reported on Line 27 derived from third party in-kind expenditures.

Tribes are permitted by statute to use in-kind expenditures from certain third party sources as a portion of their share of administrative and training costs. The option for Tribes to utilize in-kind expenditures is available only for certain fiscal years, from certain sources and up to specified limits in accordance with Section 479B(c)(1)(D) of the Act and applicable regulations.

(Enter this amount directly on this form.)

SECTION C: GUARDIANSHIP ASSISTANCE

NOTE: This section is ONLY to be completed by those States or Tribes that have an approved title IV-E plan to operate a title IV-E Guardianship Assistance Program (GAP) or by States that are continuing to incur title IV-E Post-Demonstration Guardianship expenditures after the termination of a title IV-E Guardianship Assistance demonstration project.

Line by Line Instructions

Line 29. Agency Guardianship Assistance Payments (FMAP Rate).

Enter the agency payments made on behalf of children determined to be eligible for the title IV-E Guardianship Assistance Program (GAP) in accordance with Section 473(d) of the Act.

Amounts entered on this line are only those payments made directly by the title IV-E agency. Payments made under the terms of a Tribal-State title IV-E agreement are reported separately on Line 30. This must be a “net” amount, reduced by any income specifically attributable to these payments (e.g., returned checks, overpayment refunds etc.).

Under the GAP, these payments must be in conformance with a written, binding kinship guardianship assistance agreement entered into with the prospective relative guardian prior to the legal guardianship (See Section 473(d)(1)(A) of the Act). Once the relative guardian has committed to care for the child and has assumed legal guardianship for the child consistent with the provisions of Sections 471(a)(28) and 475(7) of the Act, the title IV-E agency may then pay kinship guardianship assistance payments on behalf of a child to the relative guardian.

Payments may begin no earlier than the first day of the quarter in which the approved title IV-E plan amendment to implement the GAP was submitted to ACF by the State or Tribe (See Sections 471(a)(28) and 473(d)(1)(A) of the Act).

Payments reported on this line may include those made on behalf of newly established title IV-E kinship guardianships as well as those made on behalf of any title IV-E eligible kinship guardianships where agreements were established prior to the GAP title IV-E plan submission. These agreements must meet, or must be amended to meet, the requirements of Section 473(d)(1)(B) and (C) of the Act before these payments can be reported on this line. Payments made prior to the effective date of the approved title IV-E plan must not be reported.

The Federal share of these payments (as entered in Columns B, D and F) is computed using the applicable FMAP rate for the State or Tribe.

(Enter this amount directly on this form.)

Line 30. Tribal-State Agreement Title IV-E Guardianship Assistance Payments (Applicable FMAP Rate).

o TRIBES: Leave this line blank.

o STATES: This line is applicable only to States that have title IV-E agreements with Tribes.

Enter the payments made on behalf of children determined to be eligible for the GAP in accordance with Section 473(d) of the Act.

Amounts entered on this line are only those payments made by the State title IV-E agency in accordance with the terms of Tribal-State title IV-E agreements with one or more Federally-recognized Tribes. This must be a “net” amount, reduced by any income specifically attributable to these payments (e.g., returned checks, overpayment refunds etc.).

Under the GAP, these payments must be in conformance with a written, binding kinship guardianship assistance agreement entered into with the prospective relative guardian prior to the establishment of legal guardianship per Section 473(d)(1)(A) of the Act. Once the relative guardian has committed to care for the child and has assumed legal guardianship for the child consistent with Sections 471(a)(28) and 475(7) of the Act, the title IV-E agency may then pay kinship guardianship assistance payments on behalf of a child to the relative guardian. Such payments may begin no earlier than the first day of the quarter in which the approved title IV-E plan amendment to implement the GAP was submitted to ACF by the State (Section 471(a)(28) and 473(d)(1)(A) of the Act).

Payments reported on this line may include those made on behalf of newly established title IV-E kinship guardianships as well as those made on behalf of any title IV-E eligible kinship guardianships where agreements were established prior to the GAP title IV-E plan submission. These agreements must meet, or must be amended to meet, the requirements of Section 473(d)(1)(B) and (C) of the Act before these payments are reported on this line. Payments made prior to the effective date of the approved title IV-E plan must not be reported.

The Federal share of these payments (as entered in Columns B, D and F) is computed using either the State or Tribal FMAP rate, whichever is higher. If the State has multiple agreements with multiple Tribes, this computation is performed separately for the payments made on behalf of each Tribe.

If the State does not have a title IV-E agreement with any Federally-recognized Tribe, no entries should be made on this line.

(Enter this amount directly on this form.)

Line 31. Administrative Costs - Agency. Enter the amount of expenditures for administrative activities allocable to the title IV-E GAP, in accordance with an approved or pending public assistance cost allocation plan under Federal regulations at 45 CFR Part 95 Subpart E – Cost Allocation Plans (States) or an approved child welfare cost allocation methodology and a negotiated indirect cost rate (Tribes).

Expenditures reported on this line must be a “net” amount, offset by any income that may result from the operation of the program. Any non-recurring costs associated with obtaining legal guardianship must be reported on Line 32.

(Enter this amount directly on this form.)

Line 32. Administrative Costs - Non-Recurring. Enter the amount of expenditures for allowable non-recurring expenses associated with obtaining legal guardianship of an eligible child, to the extent that the total cost does not exceed $2,000 and is incurred in accordance with a kinship guardianship assistance agreement entered into with a qualified relative guardian prior to obtaining legal guardianship.

(Enter this amount directly on this form.)

Line 33. Training Costs – Staff, Provider and Professional Partner (At the 75 percent FFP Rate). Enter the allocated amount of expenditures incurred for the development, delivery or participation in training by eligible staff, including State or Tribe title IV-E staff serving children receiving Guardianship Assistance. (See 45 CFR 235.63 through 235.66(a) and 1356.60(b)(1)(i)). Eligible individuals include title IV-E agency staff serving children in receipt of title IV-E Guardianship Assistance.

Short-term training related to title IV-E Guardianship Assistance Care is also available for professional partner participants in accordance with Section 474(a)(3)(B) of the Act as follows:

• Relative guardians,

• Tribe/State-licensed or approved child welfare agency staff providing services to children receiving title IV-E assistance;

• Child abuse and neglect court personnel;

• Agency, child or parent attorneys;

• Guardians ad litem; and,

• Court appointed special advocates.

Professional partner training is eligible for Federal funding at the 75 percent FFP rate for periods beginning with FFY 2013 and thereafter. Federal funding was also available for periods in FFYs 2009 – 2012 at differing FFP rates that increased each year over a five-year “transitional” period (see Section 203(b) of P.L. 110-351).

The topics for all title IV-E training must be closely related to one of the examples of allowable administrative activities cited in 45 CFR 1356.60(c)(1) and (2). All training activities and costs funded under title IV-E shall be included in the IV-E agency's training plan for title IV-B.

Do not include:

• Expenditures for the training of ineligible individuals or for training on topics not determined as title IV-E eligible.

• Some costs associated with title IV-E training such as those derived through the application of an indirect cost rate may not qualify as training costs. To the extent that any such amount may be allocable to title IV-E Guardianship Assistance and qualify as an allowable administrative cost, it should be reported on Line 31.

(Enter this amount directly on this form.)

Line 34a. Demonstration Project Costs. Enter the amount for approved demonstration projects for Guardianship Assistance authorized under Section 1130 of the Act as computed on Part 3 of this form.

(This amount is carried from the amount calculated on Part 3, Line 25c of this form.)

Line 34b. Post-Demonstration Guardianship Assistance and Services Costs.

o TRIBES: Leave this line blank.

o STATES: This line is applicable only to States that formerly operated title IV-E Foster Care demonstration projects that provided guardianship assistance and services. It should not be confused with Line 34a which covers the costs of any currently approved Guardianship Assistance demonstration project.

Enter the amount for “Title IV-E Post-Demonstration Guardianship” expenditures. This line is applicable only for those States with formerly approved title IV-E Foster Care demonstration projects providing kinship guardianship assistance or services pursuant to Section 1130 of the Act that have ended. Expenditures associated with continued operation (i.e. prior quarter adjustments) or close-out of the demonstration project are to be reported in Part 3 of this report. Upon termination of such a project, the title IV-E State agency may continue to claim title IV-E for the same assistance and services under the same terms and conditions that a child received under a kinship guardianship demonstration project as of September 30, 2008. The title IV-E costs of such operations must be reported on this line. In accordance with Section 474(g) of the Act, this claiming authority exists whether or not the State opts to operate a GAP pursuant to Section 473(d) of the Act. These States must complete Section C and also report information on children assisted on Line 59 even though the option to operate a GAP has not been exercised.

In the event that there are children that began participation in an approved waiver demonstration project providing assisted guardianship on or after October 1, 2008 where the project has now been terminated, any continuing expenditures on behalf of these children incurred after termination are not to be reported on this line. Such costs may be title IV-E allowable only if the State has an approved GAP title IV-E plan amendment and then only to the extent that all title IV-E eligibility and other applicable requirements are met. If these conditions are met, expenditures on behalf of such children must be reported as part of the State title IV-E agency’s GAP claims on Lines 29 and 31.

(Enter this amount directly on this form.)

Line 35. Total Costs. This line represents the total expenditures being claimed for the current quarter (Columns A and B) and prior quarters (Columns C and D) and the total estimate for the next quarter (Columns E and F).

(Calculated as the sum of Lines 29-34b.)

Line 36. Non-Federal (State or Tribal) Share of Total Costs. This line represents in Columns B, D and F the Tribal/State share amount of total reported costs for the current quarter, prior quarter adjustments and for next quarter estimates. These are the funds that the title IV-E agency has expended or is certifying (for estimate purposes) will be made available for the required Tribal/State share of program costs.

o For States: Include funds appropriated by the State legislature for these purposes.

o For Tribes: Include funds appropriated by the Tribe and certain types and levels of in-kind expenditures (or contributions) by certain third parties, if any. (See instructions for Line 40)

(Calculated as follows:

Column B = Line 35, Column A minus Line 35, Column B;

Column D = Line 35, Column C minus Line 35, Column D and

Column F = Line 35, Column E minus Line 35, Column F.)

Line 37. Tribal Share of Costs Claimed/Estimated From Third Party In-Kind Sources.

o TRIBES: Complete this line.

o STATES: Leave this line blank. This information is not applicable to States.

Enter in Columns B, D and F the portion of the amounts reported on Line 36 derived from third party in-kind expenditures.

Tribes are permitted by statute to use in-kind expenditures from certain third party sources as a portion of their share for administrative and training costs. The option for Tribes to utilize in-kind expenditures is available only for certain fiscal years, from certain sources and up to specified limits in accordance with Section 479B(c)(1)(D) of the Act and applicable regulations.

(Enter this amount directly on this form.)

SECTION D: PREVENTION SERVICES AND KINSHIP NAVIGATOR PROGRAMS

NOTE: This section is ONLY to be completed by those States or Tribes that have an approved Title IV-E Prevention Services Plan and/or are approved to receive Kinship Navigator Program funding.

General Guidance

Title IV-E Prevention Services Program

If the title IV-E agency elects this optional program, expenditures for the Title IV-E Prevention Services Program may begin for periods as approved in a Title IV-E Plan starting no earlier than October 1, 2019. The title IV-E agency must have an approved Title IV-E Plan that includes a Prevention Services and Programs five-year plan (Section 471(e)(5) of the Act). Additionally, if the title IV-E agency elects a delayed effective date of up to two years for the following provisions: Sections 472(a)(2)(C), 472(c), 472(k), 474(a)(1), 471(a)(37), and 475A(c) of the Act, the effective date for claiming for title IV-E prevention services under Section 474(a)(6) of the Act is also delayed for the same period.

Title IV-E prevention services program eligible participants (see definition section above) may receive prevention services and programs under this program limited to mental health/substance abuse and in-home parent skill-based programs. These services and programs must meet specified practice requirements and may be provided for a time limited period of no longer than 12 consecutive months beginning on the date that a child is designated as either a “candidate for foster care” or as a “pregnant or parenting foster care youth” in accordance with a prevention plan In accordance with section 471(e)(4)(A) of the Act. The 12-month period for claiming title IV-E reimbursement for prevention services ends on the last calendar day of the 12th month.

Program expenditures for prevention services and programs made in FFY 2020 through FFY 2026 periods are reimbursable at the 50 percent FFP rate. Such expenditures made for periods beginning in FFY 2027 and later FFYs (not addressed in this version of Form CB-496) will be reimbursable at the applicable FMAP rate. These services and programs must be specified in advance in the child’s prevention plan and meet other requirements as described in Section 471(e)(4) of the Act. At least 50 percent of the expenditures by state title IV-E agencies for provision of prevention services and programs in each FFY must be for those that meet the “well-supported” practice criteria in accordance with Sections 471(e)(4)(C) and 474(a)(6)(A)(ii) of the Act. In accordance with the Public Law (P.L.) 116-94 Family First Transition Act (within Section 602, Subtitle F, Title I, Division N of the Further Consolidated Appropriations Act, 2020, enacted December 20, 2019), the practice criteria expenditure percentage requirements have been modified as follows:

• In FFY 2020 and FFY 2021 states are not required to meet the 50 percent “well-supported” expenditures requirement

• In FFY 2022 and FFY 2023, at least 50 percent of the amounts expended by the state for a FFY for the title IV-E prevention program must be for services that meet the “supported” and/or “well-supported” practice criteria”

• Beginning with FFY 2024 and for all FYs going forward, states must meet the 50 percent “well-supported” expenditures requirement as described in section 474(a)(6)(A)(ii) of the Act.

All provision of prevention services and program (regardless of the practice standard) costs claimed for title IV-E reimbursement must, unless a waiver is approved, be subject to a well-designed and rigorous evaluation strategy as specified at Section 471(e)(5)(C) of the Act. Title IV-E agencies providing title IV-E prevention services or programs must maintain the same level of “foster care prevention expenditures” each FFY as the amount the agency spent in FFY 2014. States with a child population of less than 200,000 in FFY 2014 may elect to use FFY 2015 or FFY 2016 instead of FFY 2014 for this purpose (Section 471(e)(7) of the Act). Identification and annual measurement of compliance with this maintenance of effort level will be addressed outside of Form CB-496 through a forthcoming program issuance.

Program expenditures for administrative costs (including training) attributable to prevention services and programs are reimbursable at the 50 percent FFP rate. Child specific administrative costs are limited to allowable activities performed during the same time limited period of no longer than a 12 month period as is available for provision of title IV-E prevention services. However, such administrative costs may begin as early as the first day of the calendar month during which a child is designated as either a “candidate for foster care” or as a “pregnant or parenting foster care youth” through a prevention plan In accordance with section 471(e)(4)(A) of the Act.

Additional guidance applicable to multiple lines is as follows:

• Lines 38 – 39b: Amounts entered are for delivery of allowable services and programs made directly by the title IV-E agency to a provider or to a pass-through organization including those operating under a Tribal-State title IV-E agreement. Amounts reported by state title IV-E agencies are to be broken out by the applicable classification standard (i.e. well-supported practice rather than a supported or a promising practice) for the services and programs provided as specified for each line. These services and programs are for delivery to an eligible program participant (see definitions section) child and/or the parents or kin caregivers of the child when the need for these services or programs is directly related to the safety, permanence, or well-being of the child or to preventing the child from entering foster care.

• Lines 40 – 41: Amounts consist of allowable administration and training costs on behalf of all eligible title IV-E prevention services program participants allocable to the title IV-E prevention services program. All costs must be in accordance with an approved or pending public assistance cost allocation plan under Federal regulations at 45 CFR Part 95 Subpart E – Cost Allocation Plans (States) or an approved child welfare cost allocation methodology and a negotiated indirect cost rate (Tribes). Expenditures reported on these lines must be a “net” amount, offset by any income that may result from the operation of the program.

Title IV-E Kinship Navigator Program

Title IV-E funding is available for program services and administration as per Section 474(a)(7) of the Act for the Title IV-E Kinship Navigator Program provided certain requirements are met as delineated at Section 427(a)(1) of the Act. The purpose of the program is to assist kinship caregivers in learning about, finding, and using programs and services to meet the needs of the children they are raising and their own needs. The services must be provided using promising, supported, or well-supported practices. Children in kinship care arrangements and their families are eligible for services under this program regardless of whether or not the child is currently, or is potentially, title IV-E eligible.

Administration of the title IV-E Kinship Navigator Program is optional for title IV-E agencies, and agencies must meet any requirements put forth by the Children’s Bureau. If the option is selected, title IV-E expenditures for the program are reimbursable at the 50 percent FFP rate and may begin for periods starting no earlier than October 1, 2018.

Line by Line Instructions

Line 38. Prevention Services Provision - Well-Supported Practices.

o TRIBES: Leave this line blank.

o STATES: This line is applicable only to States.

State title IV-E agencies (including Tribal-State title IV-E agreements) - Enter the expenditures and estimates for the provision of time limited eligible prevention services and programs meeting the “well-supported practice” standard provided for or on behalf of those children and their parent(s) or kin caretaker determined to be eligible as participants in the Title IV-E Prevention Services Program as either “candidates for foster care” (see definitions section) or as pregnant or parenting youth in foster care.

(Enter this amount directly on this form.)

Line 39a. Prevention Services Provision - Supported Practices.

o TRIBES: Leave this line blank.

o STATES: This line is applicable only to States.

State title IV-E agencies (including Tribal-State title IV-E agreements) - Enter the expenditures and estimates for the provision of time limited eligible prevention services and programs meeting the “supported practice” requirements at Sections 471(e)(4)(C)(iii) and (iv) of the Act, provided for or on behalf of those children and their parent(s) or kin caretaker determined to be eligible as participants in the Title IV-E Prevention Services Program as either “candidates for foster care” (see definitions section) or as pregnant or parenting youth in foster care.

(Enter this amount directly on this form.)

Line 39b. Prevention Services Provision - Promising Practices.

State title IV-E agencies (including Tribal-State title IV-E agreements) - Enter the expenditures and estimates for the provision of time limited eligible prevention services and programs meeting the “promising practice” requirements at Sections 471(e)(4)(C)(iii) and (iv) of the Act, provided for or on behalf of those children and their parent(s) or kin caretaker determined to be eligible as participants in the Title IV-E Prevention Services Program as either “candidates for foster care” (see definitions section) or as pregnant or parenting youth in foster care.

Tribal title IV-E agencies - Enter the expenditures and estimates for the provision of any time limited eligible prevention services and programs meeting the practice criteria described in the tribe’s five-year title IV-E prevention program plan, provided for or on behalf of those children and their parent(s) or kin caretaker determined to be eligible as participants in the Title IV-E Prevention Services Program as either “candidates for foster care” (see definitions section) or as pregnant or parenting youth in foster care.

(Enter this amount directly on this form.)

Line 40. Prevention Services Administrative Costs – Prevention Planning and Agency Management.

Enter the expenditures and estimates for administrative costs allocable to the Title IV-E Prevention Services Program. These costs include child specific activities directly involving the prevention planning and case management for a child determined as eligible for title IV-E prevention services and other allowable non-child specific program management administrative activities (agency management) incurred by the title IV-E agency, The costs of the direct provision of prevention services, to the extent allowable, must be reported on Lines 38 or 39, as appropriate.

Child specific administrative activities are limited to those performed during the period from the beginning of the month in which the child is identified in a prevention plan until the end of the 12th month if services were provided for the entire 12-month period, or the end of the month the child’s title IV-E prevention services ended, whichever is sooner. Allowable activities include those that comport with or are closely related to one of the listed activities at 45 CFR 1356.60(c)(2). Where the eligible child is a candidate for foster care, allowable activities are only those performed before the child is placed in foster care.

Prevention planning activities largely comport with the development and maintenance of the “prevention plan” as defined in Section 471(e)(4)(A) of the Act. Examples of activities included within case management are activities directly involving the actual verification and documentation of a child’s eligibility for the title IV-E Prevention Services program, referral to services, preparation for and participation in judicial proceedings. The performance of investigations, physical or mental examinations or evaluations are not allowable administrative activities for the Title IV-E Prevention Services Program.

Examples of activities constituting agency management administrative costs are those for program policy development, implementation and monitoring in compliance with Section 471(e) of the Act, conducting a well-designed and rigorous evaluation for prevention services practices in accordance with Section 471(e)(5)(C)(i) of the Act, completing and reporting data on child outcomes in accordance with Section 471(e)(4)(E) of the Act and operational support activities centralized in the grantee department or in some other agency such as procurement; payroll; personnel functions; management, maintenance and operation of space and property; data processing and computer services; accounting; budgeting; auditing.

 (Enter this amount directly on this form.)

Line 41. Prevention Services Training Costs – Agency Staff & Service Providers (At the 50 percent FFP rate). Enter the allocated amount of expenditures incurred for the development, delivery or participation in training by eligible staff, including State or Tribe title IV-E agency staff or persons preparing for employment by the State or Tribal agency, and the staff of State/Tribe licensed or approved child welfare agencies providing title IV-E prevention services to or on behalf of eligible children and their parents or kin caregivers. (Examples of allowable training activities include determining individuals who are eligible for the services or programs, how to identify and provide appropriate services and programs, and how to oversee and evaluate the ongoing appropriateness of the services and programs.  (Enter this amount directly on this form.)

Line 42. Prevention Services Program - Total Costs. This line represents the title IV-E Prevention Services program total expenditures being claimed for the current quarter (Columns A and B) and prior quarters (Columns C and D) and the total estimate for the next quarter (Columns E and F).

(Calculated as the sum of Lines 38-41.)

Line 43. Prevention Services Program - Non-Federal (State or Tribal) Share of Total Costs. This line represents in Columns B, D and F the Tribal/State share amount of title IV-E Prevention Services program total reported costs for the current quarter, prior quarter adjustments and for next quarter estimates. These are the funds that the title IV-E agency has expended or is certifying (for estimate purposes) will be made available for the required Tribal/State share of program costs.

o For States and Tribes: Include funds appropriated by the State legislature or the Tribe for these purposes.

(Calculated as follows:

Column B = Line 42, Column A minus Line 42, Column B;

Column D = Line 42, Column C minus Line 42, Column D and

Column F = Line 42, Column E minus Line 42, Column F.)

Line 44. Kinship Navigator Program – Provision of Services.

Enter the expenditures and estimates for provision of client services (all practice standard services including promising, supported, or well-supported practices) for or on behalf of children/families determined to be eligible as participants in the Title IV-E Kinship Navigator Program.

(Enter this amount directly on this form.)

Line 45. Kinship Navigator Program - Administrative Costs.

Enter the expenditures and estimates for all administrative costs allocable to the Title IV-E Kinship Navigator Program in accordance with an approved or pending public assistance cost allocation plan under Federal regulations at 45 CFR Part 95 Subpart E – Cost Allocation Plans (States) or an approved child welfare cost allocation methodology and a negotiated indirect cost rate (Tribes). Examples of activities constituting administrative costs are those for program policy development in compliance with Section 427(a)(1) of the Act and operational support activities centralized in the grantee department or in some other agency such as procurement; payroll; personnel functions; management, maintenance and operation of space and property; data processing and computer services; accounting; budgeting; auditing. Any expenditures incurred for the development, delivery or participation in training by eligible staff and the staff of State/Tribe licensed or approved child welfare agencies providing title IV-E kinship navigator services to or on behalf of eligible clients is also to be reported on this line, Expenditures reported on this line must be a “net” amount, offset by any income that may result from the operation of the program. (Enter this amount directly on this form.)

Line 46. Kinship Navigator Program - Total Costs. This line represents the title IV-E Kinship Navigator program total expenditures being claimed for the current quarter (Columns A and B) and prior quarters (Columns C and D) and the total estimate for the next quarter (Columns E and F).

(Calculated as the sum of Lines 44-45.)

Line 47. Kinship Navigator Program - Non-Federal (State or Tribal) Share of Total Costs. This line represents in Columns B, D and F the Tribal/State share amount of title IV-E Kinship Navigator program total reported costs for the current quarter, prior quarter adjustments and for next quarter estimates. These are the funds that the title IV-E agency has expended or is certifying (for estimate purposes) will be made available for the required Tribal/State share of program costs.

o For States and Tribes: Include funds appropriated by the State legislature or the Tribe for these purposes.

(Calculated as follows:

Column B = Line 46, Column A minus Line 46, Column B;

Column D = Line 46, Column C minus Line 46, Column D and

Column F = Line 46, Column E minus Line 46, Column F.)

SECTION E: AVERAGE MONTHLY NUMBER OF CHILDREN ASSISTED

Report the requested information for the current quarter claims (actual) and for the next quarter estimates (estimate).

Line by Line Instructions

Foster Care Program

Line 48a. Number of Children: In-Placement: Title IV-E Maintenance Assistance Payments – Foster Family Home. Enter the average monthly number of children for whom title IV-E Foster Care maintenance assistance payments reported on Lines 1a and 2a of this Part and Lines 1a and 5a of Part 3 (Foster Care) were made with respect to foster family home placements for the current quarter and are estimated to be made for the next quarter. For periods prior to the title IV-E agency’s implementation of limitations on title IV-E foster care maintenance payments for placements that are not foster family homes (Section 472(k) of the Act), a title IV-E agency may also use this line to report additional children assisted placed in child care institutions that would otherwise be reportable on lines 48b or 48c. After October 1, 2019 (or the title IV-E agency’s delayed effective date for implementing the limitations on title IV-E maintenance payments for placement that are not foster family homes), the agency must report children assisted placed in child care institutions on line 48b or 48c, as described below. Title IV-E foster care maintenance payments on behalf of children placed with a parent in a substance abuse treatment facility reportable on Line 48d must be reported on that line for all periods beginning on or after October 1, 2018.

Line 48b. Number of Children: In-Placement: Title IV-E Maintenance Assistance Payments – Specified Setting Child Care Institution. Enter the average monthly number of children for whom title IV-E Foster Care maintenance assistance payments reported on Line 1b and 2b (specified setting portion) of this Part and Lines 1a and 5a of Part 3 (Foster Care) were made with respect to specified setting child care institution placements for the current quarter and are estimated to be made for the next quarter. Children should not be reported on this line for periods beginning earlier than the effective date (including any election of a delayed effective date) of the title IV-E agency’s title IV-E Plan amendment to implement Section 472(k) of the Act.

Line 48c. Number of Children: In-Placement: Title IV-E Maintenance Assistance Payments – Non-Specified Setting Child Care Institution. Enter the average monthly number of children for whom title IV-E Foster Care maintenance assistance payments reported on Lines 1c and 2b (non-specified setting portion) of this Part and Lines 1a and 5a of Part 3 (Foster Care) were made with respect to non-specified setting child care institution placements for the current quarter and are estimated to be made for the next quarter.

Line 48d. Number of Children: In-Placement: Title IV-E Maintenance Assistance Payments – Substance Abuse Treatment Facility. Enter the average monthly number of children for whom title IV-E Foster Care maintenance assistance payments reported on Line 1d and 2b (substance abuse treatment facility portion) of this Part and Lines 1a and 5a of Part 3 (Foster Care) were made with respect to substance abuse treatment facility placements for the current quarter and are estimated to be made for the next quarter.

Line 49a. Number of Children: In-Placement - Title IV-E Funded Case Planning and Management Administrative Costs. Enter the average monthly number of children on whose behalf title IV-E Foster Care in-placement administrative costs (all placement settings) reported on Line 8 of this Part and Lines 1b and 5b of Part 3 (Foster Care) were incurred or are estimated excluding any children for whom an eligibility determination was the only activity performed.

This number includes all of the children reported on Lines 48a – 48d determined to meet all title IV-E eligibility criteria. Depending on the title IV-E agency’s approved cost allocation methodology, this number may also include certain additional title IV-E eligible children on whose behalf no assistance payments were or will be made (e.g., the child is considered to be in foster care while participating in a trial home visit for the entire quarter, or the payment is not issued during the quarter due to billing or processing delays). Finally, this number may also include children on whose behalf any assistance payments provided or expected to be provided (for estimate purposes) are not claimed as title IV-E maintenance assistance payments due to circumstances as listed below:

• Children who are eligible for title IV-E but who are receiving SSI in lieu of title IV-E Foster Care maintenance assistance payments (see the Child Welfare Policy Manual, Section 8.4D).

• In accordance with Section 472(i) of the Act, the title IV-E agency may submit a title IV-E claim for administrative costs on behalf of an otherwise eligible child placed in an unlicensed or unapproved relative home for 12 months or the average length of time it takes to license or approve a foster family home, whichever is less. During this time, an application for licensure or approval of the relative home as a foster family home must be pending (Section 472(i)(1)(A) of the Act).

Administrative costs must not be claimed for a child placed in an unlicensed or unapproved foster family home where the foster parent is not related to the child. A relative is defined by Section 406(a) of the Act as in effect on July 16, 1996, and implemented in 45 CFR 233.90(v).

• A title IV-E maintenance payment is not made on behalf of a title IV-E eligible child due to a placement in a child care institution for a period beyond which such costs are title IV-E allowable (Sections 472(k)(1) and (k))(3)).

• Administrative costs may be claimed on behalf of an otherwise title IV-E eligible child for a period of not more than one calendar month when a child moves from a facility not eligible for payments under title IV-E into a licensed or approved foster family home or child care institution (Section 472(i)(1)(B) of the Act). All such claims must also be in accordance with an approved public assistance cost allocation plan as per Federal regulations at 45 CFR 95.507 (States) or an approved child welfare cost allocation methodology (Tribes).

Line 49b. Number of Children: In-Placement - Title IV-E Funded Child or Parent Legal Representation Administrative Costs. Enter the average monthly number of children on whose behalf title IV-E Foster Care in-placement independent legal representation – child or parent administrative costs (all placement settings) reported on Line 8 of this Part were incurred or are estimated.

Line 50. Total Number of Children: In-Placement - Any Payments or Administrative Costs. Enter the average monthly number of all children in foster care (all placement settings) for whom any payments were made and/or administrative costs incurred (regardless of funding source) by the title IV-E agency. This includes all children in foster care (including those title IV-E eligible children reported on Line 49) whether or not title IV-E eligible. Foster care is defined at 45 CFR 1355.20 as 24-hour substitute care for all children placed away from their parent(s) or guardian(s) and for whom the State or Tribal agency has placement and care responsibility. Common examples of funding sources used by some title IV-E agencies for foster care include title IV-E, TANF, SSI and Tribe/State-only categories.

Line 51a. Number of Children: Title IV-E Foster Care Candidate – Title IV-E Funded Case Planning and Management Administrative Costs. Enter the average monthly number of children on whose behalf title IV-E candidate pre-placement case planning and management activity administrative costs reported on Line 10a of this Part and Lines 1b and 5c of Part 3 (Foster Care) were incurred. Do not include any children participating in the Title IV-E Prevention Services Program. These children are counted on Line 60.

These are children at imminent risk of removal from home where the State agency is either pursuing his/her removal from the home or making reasonable efforts to prevent such removal. Thus, the State or Tribe title IV-E agency has determined they are “candidates” for foster care. The title IV-E agency must also make a determination (or redetermination) at least every six months as to whether the child remains at imminent risk of removal from the home.

If pre-placement cost claims are derived through application of an allocation statistic such as the foster care eligibility rate to a pool of candidate cases, the number to be reported on this line is the average monthly number of children in that pool multiplied by the applicable allocation statistic. For example, if the total average monthly population of foster care candidates is 1,000 children and a caseload eligibility allocation statistic of 50 percent is used (in accordance with an approved cost allocation plan or methodology) to identify the title IV-E component of the cost pool(s) associated with foster care candidate cases, the title IV-E agency should report 500 (1,000 x 50 percent) as the title IV-E pre-placement caseload.



Line 51b. Number of Children: Title IV-E Foster Care Candidate – Title IV-E Funded Child or Parent Legal Representation Administrative Costs. Enter the average monthly number of children on whose behalf title IV-E candidate pre-placement independent legal representation – child or parent administrative costs reported on Line 10b of this Part were incurred. Do not include any children participating in the Title IV-E Prevention Services Program. These children are counted on Line 60.

These are children at imminent risk of removal from home where the State agency is either pursuing his/her removal from the home or making reasonable efforts to prevent such removal. Thus, the State or Tribe title IV-E agency has determined they are “candidates” for foster care. The title IV-E agency must also make a determination (or redetermination) at least every six months as to whether the child remains at imminent risk of removal from the home.

If pre-placement cost claims are derived through application of an allocation statistic such as the foster care eligibility rate to a pool of candidate cases, the number to be reported on this line is the average monthly number of children in that pool multiplied by the applicable allocation statistic. For example, if the total average monthly population of foster care candidates is 1,000 children and a caseload eligibility allocation statistic of 50 percent is used (in accordance with an approved cost allocation plan or methodology) to identify the title IV-E component of the cost pool(s) associated with foster care candidate cases, the title IV-E agency should report 500 (1,000 x 50 percent) as the title IV-E pre-placement caseload.

Line 52. Number of Children: In-Placement, Care or Supervision: Title IV-E Funded Sex Trafficking Administrative Costs. Enter the average monthly number of children on whose behalf title IV-E sex trafficking administrative costs reported on Line 10 of this Part were incurred.

These are children or youth in the placement, care or supervision of the title IV-E agency who are being screened to identify and document in agency records sex trafficking victim status or those already identified as a sex trafficking victim for whom appropriate services are being determined as per sections 471(a)(9) and (34) of the Act. It also includes use of protocols to locate and assess any child missing from foster care for the purpose of administering section 471(a)(35) of the Act, including screening the child to determine if the child is a possible sex trafficking victim.

Adoption Assistance Program

Line 53. Number of Children: Title IV-E Adoption Assistance Payments. Enter the average monthly number of children for whom the title IV-E Adoption Assistance payments reported on Lines 20 and 21 of this Part and Lines 1a and 5a of Part 3 (Adoption Assistance) were made for the current quarter and are estimated to be made for the next quarter.

Line 54. Total Number of Children: Any Adoption Assistance Payments. Enter the average monthly number of children for whom the title IV-E agency made any adoption assistance payments (regardless of funding source). This includes all children in subsidized adoptive homes (including those title IV-E eligible children reported on Line 53) whether or not title IV-E eligible.

Adoption is as defined at 45 CFR 1355.20. Adoption assistance is any recurring payment made in accordance with an adoption assistance agreement.

Line 55. Number of Children: Title IV-E Non-Recurring Administrative Cost Payments. Enter the average monthly number of children on whose behalf a non-recurring cost was reported on Line 23 of this Part and Lines 1b and 5b of Part 3 (Adoption Assistance). It should be noted that the portion of these children on whose behalf title IV-E Adoption Assistance payments are being made will also be reported on lines 53 and 54.



Guardianship Assistance Program (GAP)

NOTE: The following lines are only to be completed by those States or Tribes that have an approved title IV-E plan to operate a title IV-E GAP or by States that are continuing to incur title IV-E Post-Demonstration Guardianship expenditures after the termination of a title IV-E Guardianship Assistance demonstration project.

Line 56. Number of Children: Title IV-E Guardianship Assistance Payments. Enter the average monthly number of children for whom the title IV-E kinship guardianship assistance payments reported on Lines 29 and 30 of this Part and Lines 1a and 5a of Part 3 (Guardianship Assistance) were made for the current quarter and are estimated to be made for the next quarter.

Line 57. Total Number of Children: Any Guardianship Assistance Payments. Enter the average monthly number of children for whom the title IV-E agency made any guardianship assistance payments (regardless of funding sources). This includes all children in assisted guardianship homes (including those title IV-E eligible children reported on Line 56) whether or not title IV-E eligible. Guardianship assistance is any recurring payment made in accordance with a guardianship assistance agreement.

Line 58. Number of Children: Title IV-E Non-Recurring Administrative Cost Payments. Enter the average monthly number of children on whose behalf a non-recurring cost was reported on Line 32 of this Part and Lines 1b and 5b of Part 3 (Guardianship Assistance). The children reported on this line on whose behalf title IV-E kinship guardianship assistance payments are being made will also be reported on lines 56 and 57.

Line 59. Number of Children: Title IV-E Post-Demonstration Guardianship Assistance or Services.

o TRIBES: Leave this line blank.

o STATES: This line is applicable only to States that operate title IV-E Guardianship Assistance demonstration projects.

Enter the average monthly number of children for whom the title IV-E Post-Demonstration Guardianship Assistance or Services reported on Line 34b were made for the current quarter and are estimated to be made for the next quarter.

Title IV-E Prevention Services Program

NOTE: The following line is only to be completed by those States or Tribes that have an approved title IV-E plan to operate a title IV-E Prevention Services Program.

Line 60. Number of Children: Title IV-E Prevention Services – Any Services Provided. Enter the average monthly number of children determined as either “candidates for foster care” or “pregnant/parenting foster youth” on whose behalf title IV-E prevention services costs (all practice levels) reported on Lines 38 and 39 of this Part were incurred. Do not include children on whose behalf only title IV-E foster care candidate administration costs are reported on Line 9. These children are counted on Line 51.

Title IV-E Kinship Navigator Program

Line 61. Number of Families: Title IV-E Kinship Navigator – Any Services Provided. Enter the average monthly number of families for whom the title IV-E kinship navigator services reported on Line 44 of this Part were made for the current quarter and are estimated to be made for the next quarter. To facilitate reporting that is consistent with the other Part 1, section E lines, count each case (i.e. children and other family members served) as a single family case.

Part 2: Prior Quarter Expenditure Adjustments

Part 2 General Instructions:

Purpose and Structure This part must be submitted as a supplemental supporting document whenever a "Prior Quarter Adjustment" (Columns B and C) is reported in Part 1 of this form. Although the net total of any Part 3 derived adjustments will equal the total in section A of Part 3, it may not necessarily equal the total transferred from section D of Part 3 to Part 1 due to the potential application of cost neutrality limits. Therefore, only those Part 3 adjustments transferred to Part 1 must be identified on Part 2.

A net adjustment reported in Part 1 or Part 3 will be comprised of one or more increasing or decreasing components. Each individual adjustment should be shown and reported separately by increasing and decreasing components, if applicable. (This requirement remains in effect in instances where the combination of increasing and decreasing adjustments produced a net result of zero dollars for the Federal share of prior quarter adjustments in Part 1 or Part 3.) The appropriate funding category and applicable period must also be identified for each adjustment reported in Part 2. An identification or explanation for each adjustment (see Column E guidance below) must also be provided.

Submittal and Revisions. Part 2 is an attachment to Part 1 and Part 3. A Part 2 should be submitted whenever an initial or revised Part 1 or Part 3 is being submitted. A revised Part 2 should include all prior quarter adjustments that are applicable to the current reporting quarter, including those that are unchanged from the initial submission. A revision to this Part is subject to the same restrictions, procedures and requirements as stated for Part 1.

Part 2 Heading:

Indicate whether this Part is for prior quarter claims under the title IV-E Foster Care, Adoption Assistance Guardianship Assistance, Prevention Services or Kinship Navigator programs. Include as many copies of Part 2 as needed. Complete a separate copy for each program for which you are reporting adjustments.

Enter the name of the State or Tribe.

Enter the ending date of the current quarter from Part 1.

Check the box to indicate whether this is a new report or a revision to a report previously submitted.

Part 2 Sections Guidance:

Section A: Increasing Adjustments. Each increasing component of the net adjustments included in Part 1. (Note: In accordance with Section 1132 of the Act and 45 CFR 95, Subpart A, claims for increasing adjustments are unallowable unless submitted within two years after the calendar quarter in which the original expenditure was made or otherwise meets one of the “exception” criteria found in the statute and regulations.)

Section B: Decreasing Adjustments. Each decreasing component of the net adjustments included in Part 1. The decreasing adjustments should be entered as positive numbers on this form.

Total Increasing Adjustments (Section A) / Total Decreasing Adjustments (Section B): The last line in each section should be the total of the entries for that section, combining all copies of this form needed.

Net Adjustments. For both Columns A and B, subtract the Total Decreasing Adjustments in Section B from the Total Increasing Adjustments in Section A. The amounts entered in Columns A and B on this line must be equal to the amounts entered in Columns C and D on Line 17 (Foster Care), Line 26 (Adoption Assistance), Line 35 (Guardianship Assistance), Line 42 (Prevention Services) or Line 46 (Kinship Navigator) of Part 1 of this form.

Part 2 Columns Guidance:

Column A: Total Adjustment. The combined Federal/State or Federal/Tribe total of each adjustment.

Column B: Federal Share of Adjustment: Determine the Federal share of each adjustment by multiplying the amount in Column (A) by the FFP or FMAP rate applicable to the nature of the expenditure and the prior quarter in which it was made.

Column C: Funding Category Indicate the applicable funding category code of the component(s) on each line. A full listing of all funding categories codes broken out by applicable title IV-E program follows at the end of this section.

Column D: Applicable to Fiscal Quarter Ended. Indicate the ending date (Month and Year) applicable to the adjustment being reported. Where an otherwise single adjustment encompasses more than one calendar quarter, the portion applicable to each quarter must be shown on a separate line.

Column E: Adjustment Identification and Explanation. Provide a sufficiently detailed identification and explanation for increasing and decreasing adjustments, attaching supporting documentation as needed in accordance with the following guidance:

o For audit related adjustments: Include the finding number and, if it has been reviewed by the HHS Office of the Inspector General, the Federal audit CIN - Common Identification Number.

o For any other audit: Provide appropriate audit identifying information for each adjustment associated with a particular audit.

o For Title IV-E Eligibility Reviews: Separately identify each adjustment associated with a Title IV-E Eligibility Review. List the Period Under Review (PUR) or the date of the correspondence sent with the final report for that review.

o Other Disallowances (e.g., resulting financial report reviews, cost allocation plan reviews, site visits, etc. by federal staff): Provide a clear, sufficiently detailed explanation. Cite and attach any dated and signed correspondence as applicable.

o Significant Adjustments: Any increasing or decreasing adjustment that equals $200,000 (Total amount) or more or any group of increasing or decreasing adjustments within a single funding category that equals $1 million (Total amount) or more, must be supported through a summary statement (either in Column E or as a referenced attachment) identifying the source and reason for the claim and additional detailed information on the rationale, basis, relationship to other claims submitted on this or previous form CB-496 reports, and calculation of the adjustment.

o Two Year Filing Limit: Any increasing adjustment submitted beyond the two-year filing deadline mandated under Sec 1132 of the Social Security Act (45 CFR Part 95 Subpart A) is unallowable unless the title IV-E agency is able to thoroughly detail the nature of the claim, including an explanation establishing which of the four exceptions found at 45 CFR 95.19 supports acceptance of the untimely claim.

o Other Adjustments: Provide a summary statement identifying the source and basis for the adjustment.

Part 2 Funding Category Codes (with applicable Part 1 or Part 3 Line number):

Foster Care

FPF - Agency Maintenance Assistance Payments - Foster Family Home (Part 1, Line 1a)

FPS - Agency Maintenance Assistance Payments - Specified Setting Child Care Institution (Part 1, Line 1b)

FPN - Agency Maintenance Assistance Payments – Non-Specified Setting Child Care Institution (Part 1, Line 1c)

FPT - Agency Maintenance Assistance Payments - Substance Abuse Treatment Facility (Part 1, Line 1d)

FPA - Tribal-State Agreement Maintenance Assistance Payments - Foster Family Home (Part 1, Line 2a)

FPO - Tribal-State Agreement Maintenance Assistance Payments – Other Qualifying Placements (Part 1, Line 2b)

FAC - In-Placement Administration - Case Planning and Mgmt. (Part 1, Line 5)

FAE - In-Placement Administration - Eligibility Determination (Part 1, Line 6)

FAP - In-Placement Administration - Provider and Agency Management (Part 1, Line 7)

FAL - In-Placement Administration – Legal Representation – Child or Parent (Part 1, Line 8)

FCP - Candidate Administration - Case Planning and Management (Part 1, Line 10a)

FCL - Candidate Administration – Legal Representation – Child or Parent (Part 1, Line 10b)

FST - Sex Trafficking Administrative Costs (Part 1, Line 10c)

FNO – Non-CCWIS Operational Costs (Part 1. Line 11a)

FND – Non-CCWIS Developmental Costs (Part 1. Line 11b)

COC – CCWIS Operational Costs Using CCWIS Cost Allocation by Project No. (Part 1. Line 12a)

CON – CCWIS Operational Costs Using Non-CCWIS Cost Allocation by Project No. (Part 1. Line 12b)

CDC – CCWIS Developmental Costs Using CCWIS Cost Allocation by Project No. (Part 1. Line 13a)

CDN – CCWIS Developmental Costs Using Non-CCWIS Cost Allocation by Project No. (Part 1. Line 13b)

CNC – CCWIS Developmental Costs Using CCWIS Cost Allocation No APD (Part 1. Line 14a)

CNN – CCWIS Developmental Costs Using Non-CCWIS Cost Allocation No APD (Part 1. Line 14b)

FTS - Training Costs – Staff, Provider and Professional Partner (Part 1, Line 15)

FDD - Demonstration Project Developmental Costs (Part 3, Lines 3 and 7)

FDV - Demonstration Project Evaluation Costs (Part 3, Lines 4 and 8)

FDP - Demonstration Project FMAP Rate Operational Costs (Part 3, Lines 1a, 2a, 5a and 6a)

FDA - Demonstration Project 50% FFP Rate Operational Costs (Part 3, Lines 1b, 2b, 5b, 5c, 5d and 6b)

FDT - Demonstration Project 75% FFP Rate Operational Costs (Part 3, Lines 5e and 6c)

FPPF20 – FFY 2020 Post-Demo. Maintenance Assistance Payments - Foster Family Home (Part 3, Line 26a)

FPPS20 – FFY 2020 Post-Demo. Maint. Assist. Pymts. – Specified Setting Child Care Institution (Part 3, Line 26b)

FPPN20 – FFY 2020 Post-Demo. Maint. Assist. Pymts. – Non Spec. Setting Child Care Institution (Part 3, Line 26c)

FPAC20 – FFY 2020 Post-Demo. In-Placement Admin. - Case Planning and Management (Part 3, Line 26d)

FPCP20 – FFY 2020 Post-Demo. Title IV-E Candidate Admin. - Case Planning and Management (Part 3, Line 26d)

FPTS20 – FFY 2020 Post-Demo. Staff/Provider & Prof. Partner Training Costs (Part 3, Line 26e)

FPPF21 – FFY 2021 Post-Demo. Maintenance Assistance Payments - Foster Family Home (Part 3, Line 27a)

FPPS21 – FFY 2021 Post-Demo. Maint. Assist. Pymts. – Specified Setting Child Care Institution (Part 3, Line 27b)

FPPN21 – FFY 2021 Post-Demo. Maint. Assist. Pymts. – Non Spec. Setting Child Care Institution (Part 3, Line 27c)

FPAC21 – FFY 2021 Post-Demo. In-Placement Admin. - Case Planning and Management (Part 3, Line 27d)

FPCP21 – FFY 2021 Post-Demo. Title IV-E Candidate Admin. - Case Planning and Management (Part 3, Line 27d)

FPTS21 – FFY 2021 Post-Demo. Staff/Provider & Prof. Partner Training Costs (Part 3, Line 27e)

Adoption Assistance

APY - Maintenance Assistance Payments - Agency (Part 1, Line 20)

APA - Maintenance Assistance Payments - w/Agreement (Part 1, Line 21)

AAD - Administration - Agency (Part 1, Line 22)

AAN - Administration – Non-Recurring (Part 1, Line 23)

ATS - Training Costs – Staff, Provider and Professional Partner (Part 1, Line 24)

ADD - Demonstration Project Developmental Costs (Part 3, Lines 3 and 7)

ADV - Demonstration Project Evaluation Costs (Part 3, Lines 4 and 8)

ADP - Demonstration Project FMAP Rate Operational Costs (Part 3, Lines 1a, 2a, 5a and 6a)

ADA - Demonstration Project 50% FFP Rate Operational Costs (Part 3, Lines 1b, 2b, 5b, 5c, 5d and 6b)

ADT - Demonstration Project 75% FFP Rate Operational Costs (Part 3, Lines 5e and 6c)

Guardianship Assistance

GPY - Maintenance Assistance Payments - Agency (Part 1, Line 29)

GPA - Maintenance Assistance Payments - w/Agreement (Part 1, Line 30)

GAD - Administration - Agency (Part 1, Line 31)

GAN - Administration – Non-Recurring (Part 1, Line 32)

GTS - Training Costs – Staff, Provider and Professional Partner (Part 1, Line 33)

GPD - Post-Demonstration Guardianship Assistance and Services Costs (Part 1, Line 34b)

GDD - Demonstration Project Developmental Costs (Part 3, Lines 3 and 7)

GDV - Demonstration Project Evaluation Costs (Part 3, Lines 4 and 8)

GDP - Demonstration Project FMAP Rate Operational Costs (Part 3, Lines 1a, 2a, 5a and 6a)

GDA - Demonstration Project 50% FFP Rate Operational Costs (Part 3, Lines 1b, 2b, 5b, 5c, 5d and 6b)

GDT - Demonstration Project 75% FFP Rate Operational Costs (Part 3, Lines 5e and 6c)

Prevention Services

PWP – Prevention Services Provision - Well Supported Practices (Part 1, Line 38)

PSP – Prevention Services Provision - Supported Practices (Part 1, Line 39a)

PPP – Prevention Services Provision - Promising Practices (Part 1, Line 39b)

PAM – Prevention Services Administrative Costs – Prevention Planning and Agency Management (Part 1, Line 40)

PTS – Prevention Services Training Costs - Program Agency Staff & Service Providers (Part 1, Line 41)

Kinship Navigator

KNS – Kinship Navigator Program – Provision of Services (Part 1, Line 44)

KAD – Kinship Navigator Program – Administrative Costs (Part 1, Line 45)

Part 3: Demonstration Projects and Foster Care Post-Demonstration Costs & Funding Certainty Grant Calculations

(This Part is only applicable to those States or Tribes that have or had an approved title IV-E demonstration project.)

FOSTER CARE, ADOPTION ASSISTANCE AND GUARDIANSHIP ASSISTANCE DEMONSTRATION PROJECTS

Part 3 Demonstration Projects General Instructions (Sections A-D):

States or Tribes administering title IV-E programs (hereafter “title IV-E agency”) with an approved title IV-E demonstration project must report quarterly expenditures and/or estimates under such project(s) on Part 3 of form CB-496. All Part 3 entries are to be made in accordance with these instructions and the title IV-E agency's approved demonstration project terms and conditions and waiver authority. This includes conformance with any project-related plans required for submission and approval in accordance with the project terms and conditions.

Completion of Part 3, section B will require the development and maintenance of schedules to accumulate needed cost data by the title IV-E agency. In this context, title IV-E agencies should consider the need to develop specific fiscal operational procedures for the demonstration project. These procedures, to the extent agreed to by ACF, will govern the calculation of reported amounts. Technical assistance in the assembling of claiming documentation and the completion of Part 3 is available from ACF Regional Offices.

Title IV-E agencies will need to begin submitting Part 3 of this report prior to implementation of the demonstration project since project developmental costs and estimates of future quarterly expenditures are sought. Part 3 must also be submitted during the time period when the demonstration project is operational and for all quarters as needed after completion of the demonstration project, since evaluation costs may continue to be incurred (as per the approved terms and conditions) and prior quarter adjustment claims may be required.

Demonstration project costs reported are classified as Foster Care, Adoption Assistance or Guardianship Assistance, depending on which program component of title IV-E the project is designated to cover. Should a title IV-E agency operate separate demonstration projects for more than one title IV-E program, costs for the multiple projects must be reported separately on individual Part 3 forms. However, if a single demonstration project includes the reporting of costs attributable to more than one of these title IV-E programs, all project costs are reported under the single program with the greatest proportion of expected project operational costs (generally Foster Care). The title IV-E agency should consult with the ACF Children’s Bureau if there is any doubt as to the identification of that program. Each Part 3 form should thus be checked (one box only) to indicate whether reported costs are for the Foster Care, Adoption Assistance or Guardianship Assistance component of title IV-E.

Demonstration projects are designated as either an Experimental Design Project or as a Capped Allocation Project for financial reporting purposes. These designations describe the basic approach or method utilized to measure the cost neutrality limit (CNL) and available funding for approved activities constituting project operation, including those otherwise eligible for title IV-E funding. Section 4 of the approved terms and conditions for each demonstration project will identify the method to be utilized for the project. It is critical that each Part 3 identify in the heading which method is applicable for the reported project and that within each Part 3 section only the subsection relevant to the selected method be completed. Thus, if a project is designated as an “Experimental Design Project”, each Part 3 section will be completed only on those Lines within subsection I., Experimental Design Projects. All other Lines are to be left blank or, where consisting of totals, are automatically computed.

There may be a few situations in which a title IV-E agency is transitioning from one category of CNL method to the other. This could necessitate reporting for one or more quarters on aspects of the project subject to both methods. In these instances, both methods should be checked in the heading and all subsections will need to be completed.

When reporting information for a particular demonstration project, the State or Tribe should report on only those lines applicable for that project. The approved terms and conditions for a capped allocation project will prescribe which funding categories are included and excluded from consideration in establishing and measuring the utilization of the capped allocations. Similarly, the approved terms and conditions for an experimental design project will identify those funding categories considered for the control/comparison group in computing the average title IV-E cost per case, which is then used in calculating the cost neutrality limit.

It is critical that each Part 3 identify in the heading the applicable funding category(ies) for the reported project from among Maintenance Assistance Payments, Administration, CCWIS Operational Costs and Training. Only the lines relevant to the selected funding categories should be completed within each Part 3 section. For example, if Foster Care Maintenance Assistance Payments is the only funding category included in the project for cost neutrality purposes, only those Part 3 reporting lines designated for demonstration project operations that are titled with the words “maintenance assistance payments” or “FMAP rate” should be completed. Part 3 reporting lines that identify project operations in other funding categories or reimbursement rates are not relevant for that project. Project developmental and evaluation costs are reported regardless of the applicable funding categories.

Columns A through F should include actual expenditures only. Columns G and H should include the title IV-E agency's projection of anticipated costs (estimates) for the next quarter. Additionally, a special Column H is used on specified reporting lines to identify the title IV-E agency share.

Current quarter claims are reported in Columns A and B only for periods in which the applicable demonstration project was under development (for approved developmental costs only), operational or subject to evaluation in a post-operational quarter (per the approved terms and conditions). Since all project developmental periods have now ended and all project operations ended no later than September 30, 2019, the only demonstration project costs that may still be subject to reporting as current quarter claims for some upcoming reporting periods are those for project evaluation costs.

Prior quarter adjustments are reported in Columns C and D only for periods in which the applicable demonstration project was under development (for approved developmental costs only), operational or subject to evaluation in a post-operational quarter (per the approved terms and conditions). Any prior quarter adjustments for other periods must not be reported in Part 3. All prior quarter adjustments for demonstration project costs determined as fundable claims on line 25c must also be identified in form CB-496, Part 2. Adjustments for demonstration project costs must be identified using the appropriate funding category code for Foster Care, Adoption Assistance or for Guardianship Assistance in Part 2, Column C. For demonstration projects using an experimental design involving a control/comparison group, prior quarter adjustments reported in Part 1 may also impact the demonstration through adjustment to amounts used in the cost neutrality limit formula.

Prior quarter adjustments can either report claims not previously reported or revise the amount of a previous claim. Any prior quarter adjustment that revises the amount of a previous claim must consider the portion of the original claim that was determined as a fundable amount on the relevant reporting line (14a-b or 20a-c). The amount of the adjustment should equal the difference between the original funded claim and the revised claim. If necessary, adjustment should also be made to the cumulative holding account balance (see instructions for lines 16a-b and 22a-c). For example, if an original claim included a current quarter total of $100,000, but only $85,000 of that amount had been determined as fundable, a subsequent prior quarter adjustment to that claim must consider how much of the fundable amount is to be adjusted. Thus, continuing with this example, if the revised total claim were now $80,000, the decreasing prior quarter adjustment amount to be reported would be -$5,000 as only $85,000 of the $100,000 claim was originally funded. Additionally, if the report for the quarter with the original claim placed the unfunded $15,000 into the cumulative holding account balance, the entire $15,000 would now be removed from that reporting line as it is no longer an amount subject to reclaiming based on the revised total claim.

Part 3 Foster Care Post-Demonstration Costs & Funding Certainty Grant Calculations General Instructions (Sections E-F):

Title IV-E agencies that operated a title IV-E foster care waiver demonstration project approved under section 1130 of the Act and whose project remained in operation throughout FFY 2019 (hereinafter “former waiver agencies”) may elect to be considered for a Funding Certainty Grant (see definitions). If so, the former waiver agency must separately report all specified title IV-E foster care quarterly expenditures and/or estimates for applicable periods in FFYs 2020 and 2021 (i.e. the two FFYs after the demonstration project operational period ended) as post-demonstration costs in Part 3, section E of Form CB-496. These costs are summed in Part 3 on Line 28a and then entered in Part 1 on Line 16b to permit funding. The purpose of such separate reporting is to identify whether, and if so, to what extent, the former waiver agency is eligible for Funding Certainty Grants under the Family First Transition Act (hereinafter “Transition Act”).

Section F of Part 3 provides information relevant to the calculation and issuance of Funding Certainty Grants for FFYs 2020 and 2021. This information is populated for those former waiver agencies that are eligible for Funding Certainty Grant consideration and have completed section E through a submitted CB-496 Part 3 report. The information displayed is based on relevant data maintained by the Children’s Bureau and as reported in Part 3, section E reports. Funding Certainty Grants, however, are issued separately from title IV-E program grant awards. The purpose of Part 3, section F is thus to inform former waiver agencies of how its post-demonstration cost reporting impacts on the calculation of these grants.

The post-demonstration costs reported in Part 3, section E must be title IV-E allowable amounts that would otherwise be reportable in Part 1 for costs in only those title IV-E agency jurisdictions and title IV-E foster care funding categories (without consideration of any waivers that were formerly in place) that would have been included as project operational costs under the former demonstration project in accordance with the cost neutrality limit (CNL) provisions in the approved terms and conditions for that project. For example, if a former waiver agency had an operational demonstration project in FFY 2019 in two of its county agencies in which title IV-E foster care maintenance payments and in-placement administration were included within a capped allocation, but such costs for youth over age 18 were deemed to be outside of this project, only costs derived from the two county agencies formerly participating in the demonstration project in the funding categories subsumed within that project’s CNL are to be reported in Part 3, section E. The other title IV-E foster care costs in this example (i.e. derived from additional county agencies, other funding categories or for youth age 18 and older) are not considered as part of the former demonstration project CNL. Such costs are thus reported by funding category in Part 1.

Additionally, certain title IV-E foster care funding categories are deemed to be outside of a demonstration project CNL because they were newly created after such projects were approved. These funding categories (also identified in Part 1 instructions) are as follows:

• Line 1d. Agency Maintenance Assistance Payments – Substance Abuse Treatment Facility (FMAP Rate)

• Line 8. In-Placement Administrative Costs – Legal Representation – Child or Parent

• Line 10b. Title IV-E Foster Care Candidate Administrative Costs – Legal Representation – Child or Parent

• Line 10c. Sex Trafficking Administrative Costs

Any costs in these above listed funding categories must be reported in Part 1 regardless of whether they are associated with a jurisdiction that participated in a former demonstration project.

All Part 3, section E entries are to be made in accordance with these instructions and the former waiver agency's approved demonstration project terms and conditions. Post-demonstration costs must not be confused with demonstration projects costs which are reported in Part 3, sections A and B. Even though the operational periods for these projects all ended no later than the close of FFY 2019, there may be continuing project evaluation costs or prior quarter adjustment claims to be submitted. Therefore, such demonstration project costs must be tracked and reported separately from post-demonstration costs.

Former waiver agencies will need to complete Part 3, section E of this report for each quarter in FFY 2020 and FFY 2021 as well as in subsequent periods (up to two years after the end of the quarter) if there are any prior quarter adjustments for applicable periods in either of these FFYs to report. Each report can include current quarter claims, prior quarter adjustment claims and next quarter estimates. Current quarter and prior quarter adjustment claims reported in this section are limited to only those for applicable periods within FFYs 2020 or 2021. The post-demonstration cost claims for applicable periods in FFY 2020 must also be reported on separate lines from those for applicable periods in FFY 2021. Any cost claims for earlier or later applicable periods are outside of the scope of Funding Certainty Grant calculations and are, therefore, instead reported in Part 1. Next quarter estimates for post-demonstration costs, however, follow the nomenclature used as per the Part 1 financial information definitions. Therefore, these entries are for the quarter that will end six months after the "current (claiming) quarter" even if that date is beyond FFY 2020 or FFY 2021.

The Transition Act (section 602(c)(2)(E)) provides that reporting of post-demonstration project costs be limited to within two years of the last day of the fiscal quarter in which the expenditure was made. Therefore, the last available reporting period for post-demonstration costs for the fourth quarter of FFY 2021 applicable period will be on the CB-496 report for the quarter ending June 30, 2023. Although that report will be due on July 30, 2023, a revision may be submitted as late as September 30, 2023 (two years after the end of the last quarter considered for Funding Certainty Grant purposes).

Demonstration projects were designated either as an Experimental Design Project or as a Capped Allocation Project for financial reporting purposes. These designations describe the basic approach or method utilized to measure the CNL. However, all post-demonstration cost reporting is accomplished on a Part 3 submitted under the Capped Allocation Project designation. This approach reflects the nature of the Funding Certainty Grant calculation process which compares reported post-demonstration costs to a fixed annual allocation.

When reporting post-demonstration costs, the State or Tribe should report on only those lines applicable for its former demonstration project. The approved terms and conditions for a capped allocation project will prescribe which funding categories are included and excluded from consideration in establishing and measuring the utilization of the capped allocations. Similarly, the approved terms and conditions for an experimental design project will identify those funding categories considered for the control/comparison group in computing the average title IV-E cost per case, which is then used in calculating the CNL.

Any eligible State or Tribe electing to participate in the Funding Certainty Grant process must check the “Yes” box next to “Foster Care Post-Demonstration Cost Reporting:” in the Part 3 heading. It is also critical that each Part 3 report identify in the heading the applicable funding category(ies) for the reported project from among Maintenance Assistance Payments, Administration, and Training. Note: CCWIS Operational Costs is also listed in the Part 3 heading as a category, but was not used by any of the approved former waiver demonstrations. Only the lines relevant to the selected funding categories should be completed within Part 3, section E. For example, if Foster Care Maintenance Assistance Payments is the only funding category included in the former demonstration project for CNL purposes, only those Part 3, section E reporting lines designated for post-demonstration costs that are titled with the words “maintenance assistance payments” should be completed. Part 3, section E reporting lines that identify project operations in other funding categories are not relevant.

Columns A through F should include actual expenditures only. Columns G and H should include the title IV-E agency's projection of anticipated costs (estimates) for the next quarter. Additionally, a special Column H is used on specified reporting lines to identify the title IV-E agency share.

Prior quarter adjustments are reported in Columns C and D only for applicable periods in FFYs 2020 or 2021. Such adjustments must also be reported on the appropriate line depending on whether the claim is for an applicable period in FFY 2020 or in FFY 2021. Any prior quarter adjustments for other periods must not be reported in Part 3, section E. All prior quarter adjustments for post-demonstration costs must also be identified in form CB-496, Part 2 using the appropriate funding category code for Foster Care post-demonstration costs in Part 2, Column C.

Part 3 Definitions:

Cost Neutrality Limit. The total amount of Federal funds used to support the demonstration will not exceed the amount of Federal funds that would have been expended by the title IV-E agency under the State/Tribe plans approved under Parts B and E of title IV of the Act, if the Demonstration project were not conducted. [Section 1130 (h) of the Act]

Experimental Design. Demonstration projects employing random assignment of individuals or groups to experimental and control groups or the use of a matched comparison group in place of a control group. Cost neutrality is assessed against the average cost in the control group or, if applicable, by applying rates of growth or decline observed in the comparison group.

Capped Allocation. Project funding in each category is based on historic expenditure and caseload trends prior to implementation of the demonstration project. Cost neutrality is determined as met for allowable project expenditures up to the established cap(s).

Project Developmental Costs. Amounts incurred a IV-E agency incurs per its approved developmental cost plan to establish the demonstration project prior to initial implementation of the project anywhere within its jurisdiction.

Project Evaluation Costs. Amounts a IV-E agency incurs per its approved evaluation plan to conduct the required evaluation of the project.

Project Operational Costs. Amounts a IV-E agency incurs for the operation of a demonstration project per the approved project terms and conditions. This would include all allowable costs within specified funding categories to serve the population identified as within the scope of the project.

Title IV-E Costs. Those project operational costs a IV-E agency incurs that would be title IV-E allowable without any title IV-E waivers granted. Costs are identified by funding categories and are provided for those demonstration project participants determined as title IV-E eligible.

Project Intervention and Other Waiver Based Costs. Those project operational costs a IV-E agency incurs that would not be title IV-E allowable except for provisions in the approved project terms and conditions including any title IV-E waivers granted. Project interventions include any specific services or benefits provided to the participating population as specified in the approved project terms and conditions.

Funding Certainty Grants. Grants authorized as per section 602(c)(2)(A) of Public Law (P.L.) 116-94 (the Family First Transition Act) to provide funding certainty for certain title IV-E agencies that were operating title IV-E foster care demonstration projects under section 1130 of the Act on September 30, 2019. These grants are available for FFY 2020 and FFY 2021 for potential payments to ensure funding certainty for these former waiver agencies. Grants are calculated based on title IV-E foster care post-demonstration cost reporting.

Post-Demonstration Costs. - These include title IV-E foster care allowable amounts for applicable periods in FFYs 2020 or 2021 for performance of activities that would have been classified as within project operations chargeable or allocable to a former title IV-E foster care demonstration project which was operational on September 30, 2019 in accordance with Section 1130 of the Act and with the approved terms and conditions for that project. All post-demonstration costs must be title IV-E allowable without consideration of any waivers that were formerly in effect as per the terms and conditions (in effect on August 30, 2019) of a demonstration project. Post-demonstration costs are identified separately from other title IV-E Foster Care costs to permit an assessment of the availability of Funding Certainty Grants. The costs are reported in Part 3, Section E and the totals are summarized on Line 16b in Part 1.

Part 3 Report Heading Information:

Enter the Project Approval Date that is applicable to the project for which costs are being reported on this Part 3. This date is the one on which the authorized ACF official signed the initial set of project terms and conditions. A separate Part 3 must be completed for costs reported under each project if a title IV-E agency has received approval to operate more than one demonstration project.

• Check the appropriate box to indicate for which title IV-E program (Foster Care, Adoption Assistance or Guardianship Assistance) this Part is being completed.

• Check the appropriate box(es) to indicate which cost neutrality limit (CNL) method (Experimental Design or Capped Allocation) is applicable to the project. It is possible that some title IV-E agencies may have approval for more than one project using different CNL methods. If two demonstration projects are both funded through a single title IV-E program (e.g. Foster Care) but each project uses a different CNL method, both CNL method boxes are to be checked and all project reporting is then included on one Part 3 submission.

• Check the appropriate box (Yes or No) to indicate whether Foster Care Post-Demonstration Cost Reporting is included on this report.

• Check the appropriate box(es) to indicate the applicable funding category(ies) for the project(s) being reported. Report form entries must only be made on those lines associated with the selected applicable funding categories.

• Enter the name of the State or Tribe.

• Enter the ending date of the current quarter from Part 1.

• Enter the ending date of the next quarter from Part 1.

• Check the box to indicate whether this is a new report or a revision to a report previously submitted.

• The title IV-E agency’s applicable FMAP rate for the current quarter is automatically populated.

• The title IV-E agency’s applicable FMAP rate for the next quarter is automatically populated.

Part 3 Section Overviews

Demonstration Projects

Section A – Title IV-E Allowable and Waiver-Based Demonstration Project Costs

This section is for reporting all demonstration project costs on behalf of designated project participants and others served. This includes: 1) title IV-E allowable and allocable costs for project operations that meet title IV-E funding requirements outside any waivers granted; 2) project interventions and other costs approved through the waiver authority that are part of the operation of an implemented project, and; 3) project developmental or evaluation costs. The reported project operational costs may include maintenance assistance payments, administration, CCWIS operations and/or training on behalf of title IV-E eligible children and other designated children and families served, depending on the terms and conditions for the project.

The amounts reported on the lines with “Title IV-E” in the heading are those costs that would have been reported in Part 1 if the involved children had not been part of a demonstration project. These children must also be counted as title IV-E eligible on the appropriate line(s) in Part 1, Section E – Average Monthly Number of Children Assisted. All costs on behalf of other children and any additional types of costs for title IV-E eligible children (i.e. costs that are not title IV-E allowable absent waiver authority) deemed as allowable in accordance with waivers provided through the project are to be reported on the “Project Intervention and Other Waiver Based Expenditures” lines. Approved project development and evaluation costs are reported on separate lines since these activities are treated as demonstration project “administrative costs” rather than “operational costs”. These costs are thus subject to reimbursement without consideration of any cost neutrality limit identified (see Section B below).

Section B - Cost-Neutrality Calculations

This section provides an accounting summary of the cumulative (life of the project) cost neutrality limit (CNL). This section also shows whether all of the current quarter and prior quarter adjustment project operational costs from Section A are fundable. If these reported expenditures exceed the CNL as of the reporting quarter, this section provides for the recording of a title IV-E claim to be maintained in a “holding account” until a quarter in which funds become available in accordance with the CNL calculations.

Section C – Project Savings/Unused Allocations

This section provides the cumulative (life of the project) available funding for additional project operations including activities that are title IV-E allowable or approved project interventions and other services.

Project interventions are those forms of assistance and the provision of activities specifically approved as part of the demonstration strategy to achieve identified goals. These cost components are not allowable for title IV-E reimbursement absent the waiver authority. Provision of other services includes all other project operational expenditures that are in accordance with the waivers provided through the demonstration terms and conditions and that are not reported elsewhere in this Part for title IV-B or title IV-E purposes.

The cumulative funds available after the reporting of all project operational costs are typically referred to as expenditure of “savings” for experimental design projects since they include funds that under the cost neutrality limit (CNL) would have been spent for title IV-E allocable costs if no waiver authority had been granted. In capped allocation projects, such amounts are properly classified as “unused allocations” since they represent the difference between total operational costs and the available allocation. Although savings are generated through specific title IV-E funding activity categories (e.g., maintenance assistance payments) to assure title IV-E cost neutrality, savings amounts available through each funding category may be expended for any project intervention or other purpose authorized in the project terms and conditions.

Section D - Fundable Claims/Estimates

This section summarizes total fundable claims and estimates for all demonstration projects identified for a title IV-E program. The total fundable amounts (Line 25c) are then transferred to Part 1 of form CB-496 to incorporate them into the reported program totals utilized in calculating grant awards.

Foster Care Post-Demonstration Costs & Funding Certainty Grant Calculations

Section E – Foster Care Post-Demonstration Costs – Funding Certainty Grant Calculation Data

This section is for reporting all FFY 2020 and FFY 2021 foster care post-demonstration costs for those title IV-E agencies that formerly had an approved demonstration project in operation as of the close of FFY 2019 and which elect to be considered for the purpose of issuing Funding Certainty Grants.

Post-demonstration costs are title IV-E foster care allowable amounts for periods in either FFY 2020 or FFY 2021 that would have been classified, had they been incurred on September 30, 2019, as within project operations for an approved demonstration project. These costs would ordinarily be reported on specified lines in Part 1. However, such costs must now be reported in Part 3, section E for purposes of identifying the availability of Funding Certainty Grants. The children served through costs reported in Part 3, section E must also be counted as title IV-E eligible on the appropriate line(s) in Part 1, section E – Average Monthly Number of Children Assisted.

All costs reported in Part 3, section E must be title IV-E allowable without consideration of any waivers that were formerly in effect as per the terms and conditions of a demonstration project. The Part 3, section E total is also entered in Part 1 on Line 16b for title IV-E funding purposes.

Note: Any costs attributable to a formerly operational demonstration project, must be reported in Part 3, section A. Such costs are limited to prior quarter adjustment claims except for any possible costs for approved ongoing project evaluation activities.

Section F - Funding Certainty Grant Calculations

This section provides information on the baseline used in the calculation of Funding Certainty Grants and also summarizes the status of any calculations to date with respect to potential or already issued awards through this grant for FFY 2020 or FFY 2021. Section F does not require any data entry.

Part 3 Line-by-Line Instructions

I. Experimental Design Projects

Line 1a. Title IV-E Maintenance Assistance Payments Operations (FMAP Rate) – This line includes title IV-E allowable (without waiver authority) maintenance assistance payments on behalf of children participating as part of the ever-assigned experimental group in the approved and operational title IV-E demonstration project where maintenance assistance payments are considered as part of the CNL. These costs are to be used in the cost neutrality calculation. Any amount reported on this line should not be reported in Part 1, Lines 1-15 for Foster Care, Lines 20-24 for Adoption Assistance or Lines 29-33 & 34b for Guardianship Assistance.

For a Foster Care project, these costs may only cover the items classified as title IV-E maintenance payments in Section 475(4)(A) of the Act for children determined to be title IV-E eligible and form CB-496, Part 1 instructions for Lines 1a, 1b, 1c, 2a and 2b. Costs for title IV-E maintenance payments on behalf of a child placed with a parent residing in a licensed residential family-based treatment facility for substance abuse (see Substance Abuse Treatment Facility Placements in the Part 1 definitions section) are not subject to a demonstration project CNL and must, therefore, be reported in Part 1 on Line 1d rather than on this line. Title IV-E maintenance assistance payments made through a Tribal-State title IV-E agreement may also not be subject to a demonstration project CNL (unless specified as such in the approved terms and conditions) and must, in that instance, be reported in Part 1 on Lines 2a or 2b rather than on this line. The Federal share of any child support collections made on behalf of the children whose maintenance payments are reported on this line must be reported in Part 1, Line 3.

For an Adoption Assistance demonstration project, these costs are subject to the limitation specified in Section 473(a)(3) of the Act for children determined to be title IV-E eligible and form CB-496, Part 1 instructions for Lines 20 and 21.

For a Guardianship Assistance demonstration project, these costs are subject to the limitation specified in Section 473(d)(2) of the Act for children determined to be title IV-E eligible and form CB-496, Part 1 instructions for Lines 29 and 30.

Do not include:

• Costs on behalf of children participating in the demonstration project as part of a control or comparison group. Such amounts are demonstration-related expenditures, but are reported in Part 1 and are utilized in Section B of this report for cost neutrality purposes.

• Additional project operations costs (i.e. other than title IV-E assistance payments) for the children assisted through the demonstration project. Such costs are reported elsewhere in this Part.

(Enter amounts directly on this form in Columns A, C, D and G for Experimental Design projects. Columns B, E, F and H are automatically calculated to display Federal share or totals.)

Line 1b. Title IV-E Administration (All Applicable Categories) Operations (50 Percent FFP Rate) - Amounts reported on this line are title IV-E allowable (without waiver authority) administrative costs on behalf of children participating as part of the ever-assigned experimental group in the approved and operational title IV-E demonstration project where administration is considered as part of the CNL. These costs are to be used in the cost neutrality calculation. Any amount reported on this line should not be reported in Part 1, Lines 1-15 for Foster Care, Lines 20-24 for Adoption Assistance or Lines 29-33 & 34b for Guardianship Assistance. This line should remain blank if costs in the administration funding category are not subject to a CNL under the reported project.

For a Foster Care project, these costs may only cover the items classified as title IV-E in-placement or candidate administration in accordance with Federal regulations at 45 CFR 1356.60(c) and form CB-496, Part 1 instructions for Lines 5 – 9.

For an Adoption Assistance or a Guardianship Assistance demonstration project, these costs may only cover the items classified as title IV-E administrative costs – agency or administrative costs – non-recurring in accordance with Federal regulations at 45 CFR 1356.60(c) and form CB-496, Part 1 instructions for Lines 22 – 23 (Adoption Assistance) or Lines 31 – 32 (Guardianship Assistance).

Do not include:

• Costs on behalf of children participating in the demonstration project as part of a control or comparison group. Such amounts are demonstration project-related expenditures, but they are reported in Part 1 and are utilized in Section B of this report for cost neutrality purposes.

(Enter amounts directly on this line in Columns A, C and G for Experimental Design projects where and to the extent that, administrative costs are considered in the CNL. Columns B, D, E, F and H are automatically calculated to display Federal share or totals.)

Line 2a. FMAP Rate – Project Intervention and Other Waiver-Based Expenditures - The amounts reported on this line can include: 1) expenditures for project interventions; 2) otherwise not claimed title IV-B/IV-E eligible activities that are in accordance with the approved waiver demonstration terms and conditions; or 3) amounts applied from the FMAP rate expenditures cumulative holding account (Line 16a). If holding account amounts (accumulated on previous Part 3 reports) are included on Line 2a, an appropriate deduction to Line 16a should appear on this and future quarterly demonstration project reports using the form CB-496, Part 3. The title IV-E agency should also maintain supporting documentation establishing how all amounts were expended.

Line 2a provides for reporting of costs at the FMAP rate for all other approved project operations fundable up to the available amount, excluding those reportable in Section A as title IV-E allowable (without a waiver) and as project developmental or evaluation costs. If the project is also assessed for cost neutrality purposes based on administrative costs, another option to report these costs (at the 50% FFP rate) is available on Line 2b.

The title IV-E agency should first determine the availability of funding on Line 2a through “test” completion of Section B (Cost Neutrality). This can be done by following the Section B instructions listed below; however, when completing line 12a, enter only cumulatively funded amounts plus currently reported amounts on line 1a. The title IV-E agency will then be able to identify in Section C (Project Savings/Unused Allocations) any amount available for expenditure at the FMAP rate on Line 23a. The title IV-E agency can then report any claims as appropriate on Line 2a and include those amounts on Line 12a per the instructions below. Any claims filed on Line 2a which exceed the calculated cost neutrality limit will automatically be identified as part of the FMAP rate holding account (Line 16a) on this quarter’s report.

Total computable amounts are reported in Column A if expended in the reporting quarter or in Column C if expended in a previous quarter. The appropriate level of title IV-E agency match (using the applicable FMAP rate) should be used for all expenditures of available demonstration project savings reported on this line. Columns E and F serve as an automatic check to assure that amounts are not reported in Columns A-D unless calculated as available.

(Enter amounts directly in Columns A, C, D and G for Experimental Design projects. Columns B, E, F and H are automatically calculated to display Federal share or totals.)

Line 2b. 50 Percent FFP Rate – Project Intervention and Other Waiver-Based Expenditures - The amount reported can include: 1) expenditures for project interventions; 2) otherwise not claimed title IV-B/IV-E eligible activities that are in accordance with the approved waiver demonstration terms and conditions; or 3) amounts applied from the 50 percent FFP expenditures cumulative holding account (Line 16b). If holding account amounts (accumulated on previous Part 3 reports) are included on Line 2a, an appropriate deduction to Line 16b should appear on this and future quarterly demonstration project reports using the form CB-496, Part 3. The title IV-E agency should also maintain supporting documentation establishing how all amounts were expended.

Line 2b provides for reporting at the 50 percent FFP rate of costs for all other approved project operations (fundable up to the available amount), excluding those reportable in Section A as title IV-E allowable (without a waiver) and as project developmental or evaluation costs. It should be noted that another option may be available to report these costs at the FMAP rate on Line 2a.

The title IV-E agency should first determine the availability of funding on Line 2b through “test” completion of Section B (Cost Neutrality). This can be done by following the Section B instructions listed below; however, when completing Line 12b, enter only cumulatively funded amounts plus currently reported amounts on Line 1b. The title IV-E agency will then be able to identify in Section C (Project Savings/Unused Allocations) any amount available for expenditure at the 50 percent FFP rate on Line 23b. It can then report any claims as appropriate on Line 2b and include those amounts on Line 12b (per below instructions). Any claims filed on Line 2b, which exceed the calculated cost neutrality limit, will automatically be identified as part of the 50 percent FFP rate holding account (Line 16b) on this quarter’s report.

Total computable amounts are reported in Column A if expended in the reporting quarter or in Column C if expended in a previous quarter. The appropriate level of title IV-E agency match (at the 50 percent FFP rate) should be used for all expenditures of available demonstration project savings reported on this line. Columns E and F serve as an automatic check to assure that amounts are not reported in Columns A-D unless calculated as available.

(Enter amounts directly in Columns A, C and G for Experimental Design projects only where administrative costs are considered for cost neutrality limit determination purposes. Columns B, D, E, F and H are automatically calculated to display Federal share or totals.)

Lines 3. Project Developmental Costs (50 Percent FFP Rate) - These are the costs associated with the development of the demonstration proposal. This includes costs for the performance of project activities undertaken before implementation of the demonstration project in accordance with the approved waiver terms and conditions and the title IV-E agency's approved developmental cost plan. These demonstration costs are treated as project administration at the 50 percent rate of FFP and are not subject to the cost-neutrality calculation. Developmental costs must cease prior to the date the project is deemed implemented (operational) anywhere in the State or the Tribe’s service area.

(Enter amounts directly in Columns A, C and G on Line 3 for Experimental Design Group projects. Columns B, D, E, F and H are automatically calculated on each line to display Federal share or totals.)

Lines 4. Project Evaluation Costs (50 Percent FFP Rate) - These are the costs associated with the performance of a project evaluation in accordance with the approved waiver terms and conditions and the IV-E agency's approved evaluation plan. These demonstration costs are treated as project administration at the 50 percent rate of FFP and are not subject to the cost-neutrality calculation. Evaluation costs may begin with the quarter when the project is implemented (operational) anywhere in the IV-E agency and might extend for a period beyond the completion of the demonstration project. In this case, Part 3 must be completed to identify such costs even though there may be no other demonstration expenditures or need for a cost-neutrality calculation. Pre-implementation approved evaluation planning and preparation costs are reported as part of developmental costs.

(Enter amounts directly in Columns A, C and G on Line 4 for Experimental Design Group projects. Columns B, D, E, F and H are automatically calculated on each line to display Federal share or totals.)

Line 11a. Maintenance Payments (FMAP Rate) - Cumulative Experimental Group Title IV-E Cost Neutrality Limit (CNL) - The Federal Share amounts to be entered in Columns F and H result from maintenance payment calculations in accordance with the approved terms and conditions on cost-neutrality contained in each title IV-E agency's waiver. This represents the maximum amount of Federal funding at the FMAP rate available through this reporting period for reimbursement of allowable experimental group demonstration project operational expenditures (Column F) and future estimates (Column H).

The cumulative CNL calculation must be performed using data on demonstration experimental and control/comparison groups’ quarterly costs through the current quarter (expenditure purposes) and the next quarter (estimating purposes) in accordance with the approved project terms and conditions through a separate spreadsheet. The resulting totals are entered on this line.

Control/comparison group costs are no longer reported in Part 3 but must still be tracked by the title IV-E agency to perform the CNL calculation. The title IV-E agency will also require information on the number of "cases" in both the experimental and the control/comparison groups. A separate spreadsheet identifying the title IV-E agency's CNL calculations should be maintained at the title IV-E agency as supporting documentation.

(Enter amounts directly in Columns F and H for Experimental Design projects. The Column H amount should equal the Column F amount plus the title IV-E agency's estimate of the additional CNL amounts projected for the two subsequent quarters following the current quarter, which includes the quarter during which this claim is being filed and the quarter for next quarter estimates.)

Line 11b. Administrative Costs (50 Percent FFP Rate) - Cumulative Experimental Group Title IV-E Cost Neutrality Limit (CNL) - The Federal share amounts to be entered in Columns F and H result from administration calculations in accordance with the approved terms and conditions on cost-neutrality contained in each IV-E agency's waiver. This represents the maximum amount of Federal funding at the 50 percent FFP rate available through this reporting period for reimbursement of allowable experimental group demonstration project operational expenditures (Column F) and future estimates (Column H).

The cumulative CNL calculation must be performed using data on demonstration experimental and control/comparison groups’ quarterly costs through the current quarter (expenditure purposes) and the next quarter (estimating purposes) in accordance with the approved project terms and conditions through a separate spreadsheet. The resulting totals are entered on this line.

Control/comparison group costs are no longer reported in Part 3 but must still be tracked by the title IV-E agency to perform the CNL calculation. The title IV-E agency will also require information on the number of "cases" in both the experimental and the control/comparison groups. A separate spreadsheet identifying the title IV-E agency's CNL calculations should be maintained at the IV-E agency as supporting documentation.

(Enter amounts directly in Columns F and H for Experimental Design projects where administrative costs are considered in the CNL. The Column H amount should equal the Column F amount plus the title IV-E agency's estimate of the additional CNL amounts projected for the two subsequent quarters following the current quarter, which includes the quarter during which this claim is being filed and the quarter for next quarter estimates.)

Line 12a. FMAP Rate - Currently Reported and Cumulatively Funded Experimental Group and Other Operational Costs - The amount reported represents all operational costs reported over the life of the project as title IV-E maintenance payments or other costs subject to the FMAP rate, minus any previously reported amounts that were determined as not fundable.

The Column F entry is the total of Lines 1a and 2a on the current report and the total of Line 12a minus Line 15a from the previous quarter's demonstration project form CB-496, Part 3 report (all amounts taken from Column F). The title IV-E agency must adjust this figure to exclude any expenditure amount not reimbursable because it was disallowed. If a disallowance action is appealed, the title IV-E agency should not reduce the Line 12a total if it decides to retain the funds pending a decision. In addition, should the title IV-E agency prevail in the appeal, a further adjustment to this line may be necessary.

The Column H entry is the sum of: Step 1) Column F amount minus any Line 15a Column F entries plus the Column H entries on Lines 1a and 2a. Step 2) Add the total of Column H, Lines 1a and 2a, minus Line 15a Column H entries from the previous quarter’s form CB-496, Part 3 report to account for the one additional quarter funded through grant award authority, but not yet subject to expenditure reporting.

(Enter amounts directly in Columns F and H for Experimental Design projects. These entries are determined from amounts reported on this and the prior quarter’s Part 3 submissions as noted above).

Line 12b. 50 percent FFP Rate - Currently Reported and Cumulatively Funded Experimental Group and Other Operational Costs - The amount reported represents all operational costs reported over the life of the project as title IV-E administrative or other costs subject to the 50 percent FFP rate minus any previously reported amounts that were not fundable.

The Column F entry is the total of Lines 1b and 2b on the current report and the total of line 12b minus line 15b from the previous quarter's Demonstration Projects form CB-496, Part 3 report (all amounts taken from Column F). The IV-E agency must adjust this figure to exclude any expenditure amount not reimbursable because it was disallowed. If a disallowance action is appealed, the IV-E agency should not reduce the line 12b total if it decides to retain the funds pending a decision. In addition, should the IV-E agency prevail in the appeal, a further adjustment to this line may be necessary.

The Column H entry is the sum of: Step 1) Column F amount minus any Line 15b Column F entries plus the Column H entries on Lines 1b and 2b. Step 2) Add the total of Column H Lines 1b and 2b minus line 15b Column H entries from the previous quarter’s form CB-496, Part 3 report to account for the one additional quarter funded through grant award authority, but is not yet subject to expenditure reporting.

(Enter amounts directly in Columns F and H for Experimental Design projects. These entries are determined from amounts reported on this and the prior quarter’s Part 3 submission as noted above).

Line 13a. FMAP Rate – Cumulative Experimental Group and Other Operational Costs in Excess of CNL –The amount reported represents any currently reported or previously funded project operational costs at the FMAP rate that exceed the cumulative Experimental Design CNL for this funding category calculated on this report. This line is calculated based on entries on Lines 11a and 12a. The formula applied is the following: Line 12a minus Line 11a. Amounts in Column F are treated as zero (0) if the result is a negative number. A positive number is recorded as calculated. The result of these steps is entered in Columns F and H of this line and constitutes the cumulative amount in excess of CNL for the FMAP rate funding category. If this total exceeds the total reported on Lines 1a plus 2a, a portion of previously funded costs are now also in excess of the calculated CNL. No reconciliation will be made for this potential funding overage until the quarter in which claiming for project operations is completed.

(No entries are required. All columns are calculated for Experimental Design projects as noted above.)

Line 13b. 50 percent FFP Rate - Cumulative Experimental Group and Other Operational Costs in Excess of CNL – The amount reported represents any currently reported or previously funded project operational costs at the 50 percent FFP rate that exceed the cumulative Experimental Design CNL for this funding category calculated on this report. This line is calculated based on entries on Lines 11b and 12b. The formula applied is the following: Line 12b minus Line 11b. Amounts in Column F are treated as zero (0) if the result is a negative number. A positive number is recorded as calculated. The result of these steps is entered in Columns F and H of this line and constitutes the cumulative amount in excess of CNL for the 50 percent FFP rate funding category. If this total exceeds the total reported on Lines 1b plus 2b, a portion of previously funded costs are now also in excess of the calculated CNL. No reconciliation will be made for this potential funding overage until the quarter in which claiming for project operations is completed.

(No entries are required. All columns are calculated for Experimental Design projects as noted above.)

Line 14a. FMAP Rate - Fundable Portion of Total Quarterly Project Operational Costs - Amounts are initially calculated in Columns F and H only. The amount entered is equal to Line 1a plus 2a minus Line 15a. This is the maximum amount of the reported title IV-E costs subject to Federal funding at the FMAP rate as of the date reported. If these expenditure/estimate amounts match the amounts reported in the equivalent columns on Lines 1a plus 2a, the remaining Line 14a columns are completed by copying data from Lines 1a plus 2a. However, if there is a difference between these totals, the resulting Line 14a total Federal share expenditure amount is automatically apportioned between current and prior quarter amounts in accordance with the relative percentages attributable to each category on Lines 1a and 2a, Columns B and D. The amounts entered in the total computable columns (Columns A, C F and G) are also automatically calculated by dividing the Federal share amount (Columns B, D and H) by the calculated FFP rate. The calculated FFP rate is equal to the Line 1a plus 2a Federal share amount in the same column, divided by the associated total computable column (e.g., Column B/Column A).

(No entries are required. All columns are calculated for Experimental Design projects as noted above.)

Line 14b. 50 percent FFP Rate - Fundable Portion of Total Quarterly Project Operational Costs - Amounts are initially calculated in Column F and H only. The amount entered is equal to line 1b plus 2b minus line 15b. This is the maximum amount of the reported title IV-E costs subject to Federal funding at the 50% FFP rate as of the date reported. If these expenditure/estimate amounts match the amounts reported in the equivalent columns on Lines 1b plus 2b, the remaining line 14b columns are automatically completed by copying data from Lines 1b plus 2b. If, however, there is a difference between these totals, the resulting line 14b total Federal share expenditure amount is automatically apportioned between current and prior quarter amounts in accordance with the relative percentages attributable to each category on Lines 1b and 2b, Columns B and D. The amounts entered in the total computable columns (Columns A, C F and G) are also automatically calculated by dividing the Federal share amount (Columns B, D and H) by the calculated rate of Federal financial participation (FFP). The calculated FFP rate is equal to the line 1b plus 2b Federal share amount in the same column divided by the associated total computable column (e.g., Column B/Column A).

(No entries are required. All columns are calculated for Experimental Design projects as noted above.)

Line 15a. FMAP Rate - Non-Fundable Portion of Total Quarterly Project Operational Costs - This line represents the amount of any reported FMAP rate operational cost claims that exceed the CNL calculation and are thus not currently fundable. Amounts are initially calculated in Column F and H only. The amount is determined by comparing the line 1a plus 2a subtotal to the line 13a entry in the same column. If this subtotal exceeds or equals the line 13a entry, the full amount of the line 13a entry is entered in the same column on line 15a. If the calculated subtotal is less than the line 13a entry in the same column, the formula used is as follows: [line 13a – (line 13a – line 1a – line 2a)]. Special Note: If the sum of the column F amounts on Lines 1a plus 2a results in a negative number, no further calculations are needed and a zero is entered in column F on this line. This step is necessary to permit acceptance of net decreasing adjustments in a funding category without applying a cost neutrality related impact. The result of the above calculation is the portion (if any) of the reported project operational costs subject to Federal funding at the FMAP rate that exceed the calculated CNL and are thus non-fundable.

If the calculated Column F and H amounts are equal to zero, the remaining line 15a columns are automatically completed by entering zeroes. If, however, Column F has a calculated entry greater than zero, the resulting line 15a total Federal share expenditure amount is automatically apportioned between current and prior quarter amounts in accordance with the relative percentages attributable to each category on Lines 1a and 2a, Columns B and D. The amounts entered in the total computable columns (Columns A, C E and G) are also automatically calculated by dividing the Federal share amount (Columns B, D and H) by the calculated rate of Federal financial participation (FFP). The calculated FFP rate is equal to the line 1a plus 2a Federal share amount in the same column divided by the associated total computable column (e.g., Column B/Column A).

(No entries are required. All columns are calculated for Experimental Design projects as noted above.)

Line 15b. 50 percent FFP Rate - Non-Fundable Portion of Total Quarterly Project Operational Costs - This line represents the amount of any reported 50 percent FFP rate operational cost claims that exceeds the CNL calculation and is thus not currently fundable. Amounts are initially calculated in Columns F and H only. The amount is determined by comparing the Line 1b plus 2b subtotal to the line 13b entry in the same column. If this subtotal exceeds or equals the line 13b entry, the full amount of the line 13b entry is entered in the same column on line 15b. If the calculated subtotal is less than the line 13b entry in the same column, the formula used is as follows: [line 13b – (line 13b – line 1b – line 2b)]. Special Note: If the sum of the column F amounts on Lines 1a plus 2a results in a negative number, no further calculations are needed and a zero is entered in column F on this line. This step is necessary to permit acceptance of net decreasing adjustments in a funding category without applying a cost neutrality related impact. The result of the above calculation is the portion (if any) of the reported project operational costs subject to Federal funding at the 50 percent FFP rate that exceed the calculated CNL and are thus non-fundable.

If the calculated Columns F and H amounts are equal to zero, the remaining Line 15b columns are automatically completed by entering zeroes. If, however, Column F has a calculated entry greater than zero, the resulting Line 15b total Federal share expenditure amount is automatically apportioned between current and prior quarter amounts in accordance with the relative percentages attributable to each category on Lines 1b and 2b, Columns B and D. The amounts entered in the total computable columns (Columns A, C E and G) are also automatically calculated by dividing the Federal share amount (Columns B, D and H) by the calculated FFP rate. The calculated FFP rate is equal to the Line 1b plus 2b Federal share amount in the same column divided by the associated total computable column (e.g., Column B/Column A).

(No entries are required. All columns are calculated for Experimental Design projects as noted above.)

Line 16a. FMAP Rate - Cumulative Holding Account (Unfunded Operational Costs In Excess of CNL) - A cumulative holding account balance for the FMAP rate CNL calculation must be established to assure that these reported expenditures are properly tracked. Although this amount will sometimes be equal to the Line 13a total on this report, it can differ based on prior project operations. An entry is reportable only in Column F. The amount reported is the cumulative total current balance of the holding account for this funding rate. That number is equal to the Column F entry on Line 15a of the current report, plus Line 16a from the previous quarter's demonstration project form CB-496, Part 3 report, minus any adjustments.

Adjustments to the holding account can result from either a determination that an amount is no longer reimbursable or a movement of previously reported holding account amounts to Line 2a (expenditure of available savings reported in this quarter). When demonstration project savings are generated, the title IV-E agency should consider using these funds first as reimbursement of holding account expenditures. Supporting documentation should be maintained by the title IV-E agency to demonstrate the results of this analysis of the holding account amount each quarter.

Amounts should not ordinarily remain in the holding account beyond the last quarter during which the associated waiver demonstration project is operational in accordance with the approved terms and conditions. The holding account entry may continue to be reported for several quarters after the completion of the demonstration project operations, if the title IV-E agency intends to report prior quarter adjustments (for periods when the project was in operation) to demonstration project expenditures. However, Federal regulations at 45 CFR 95.7 impose time constraints for the reporting of increasing adjustment claims. Any amounts pending beyond this limit should be removed from the holding account as no longer subject to reimbursement.

(Enter an amount, if any, for Experimental Design projects in Column F only. This entry is derived both from data reported elsewhere on this submission and any entry on Line 16a from the previous quarter’s report as noted above.)

Line 16b. 50 Percent FFP Rate - Cumulative Holding Account (Unfunded Operational Costs In Excess of CNL) - A cumulative holding account balance for the 50 percent FFP rate CNL calculation must be established to assure that these reported expenditures are properly tracked. Although this amount will sometimes be equal to the Line 13b total, it can differ based on prior project operations. An entry is reportable only in Column F. The amount reported is the cumulative total current balance of the holding account for this funding rate. That number is equal to the Column F entry on Line 15b of the current report plus Line 16b from the previous quarter's demonstration projects form CB-496, Part 3 report, minus any adjustments.

Adjustments to the holding account can result from either a determination that an amount is no longer reimbursable or a movement of previously reported holding account amounts to Line 2b (expenditure of available savings reported in this quarter). When demonstration project savings are generated, the title IV-E agency should consider using these funds first as reimbursement of holding account expenditures. Supporting documentation should be maintained by the title IV-E agency to demonstrate the results of this analysis of the holding account amount each quarter.

Amounts should not ordinarily remain in the holding account beyond the last quarter during which the associated waiver demonstration project is operational in accordance with the approved terms and conditions. The holding account entry may continue to be reported for several quarters after the completion of the demonstration project operations if the title IV-E agency intends to report prior quarter adjustments (for periods when the project was in operation) to demonstration project expenditures. However, Federal regulations at 45 CFR 95.7 impose time constraints for the reporting of increasing adjustment claims. Any amounts pending beyond this limit should be removed from the holding account as no longer subject to reimbursement.

(Enter an amount, if any, for Experimental Design projects in Column F only. This entry is derived both from data reported elsewhere on this submission and any entry on Line 16a from the previous quarter’s report as noted above.)

Line 23a. Maintenance Payments (FMAP Rate) - Title IV-E Savings Remaining Available for Expenditure - This line represents the amount of savings generated during the life of the demonstration project now remaining available for expenditure with Federal reimbursement at the FMAP rate. It consists of the total over the life of the project’s operations by which the FMAP rate CNL exceeds currently reported and previously funded FMAP rate expenditures. The calculation includes Line 11a minus Line 12a. This amount is reported as Federal share only in Column F. An entry of zero (0) is made unless the result of the calculation is a positive number. For informational purposes only, a special Column H entry is calculated to identify the estimated title IV-E agency share that would be required to be expended to claim the full amount shown in Column F and a Column E entry is calculated to display the estimated total computable amount of savings. These amounts are labeled as “estimated” since the savings may actually be expended in a subsequent FFY where the matching rate may differ from that applied to reported current quarter claims on this report.

(No entries are required. All columns are calculated for Experimental Design projects as noted above.)

Line 23b. Administration (50 Percent FFP Rate) - Title IV-E Savings Remaining Available for Expenditure - This line represents the amount of savings generated during the life of the demonstration project now remaining available for expenditure with Federal reimbursement at the 50 percent FFP rate. It consists of the total over the life of the project’s operations by which the 50 percent FFP rate CNL exceeds currently reported and previously funded 50 percent FFP rate expenditures. The calculation includes Line 11b minus Line 12b. This amount is reported as Federal share only in Column F. An entry of zero (0) is made unless the result of the calculation is a positive number. For informational purposes only, a special Column H entry is calculated to identify the estimated title IV-E agency share that would be required to be expended to claim the full amount shown in Column F and a Column E entry is calculated to display the estimated total computable amount of savings. These amounts are labeled as “estimated” since the savings may actually be expended in a subsequent FFY where the matching rate may differ from that applied to reported current quarter claims on this report.

(No entries are required. All columns are calculated for Experimental Design projects as noted above.)

II. Capped Allocation Projects

Line 5a. Title IV-E Maintenance Assistance Payments Operations (FMAP Rate) –This line includes title IV-E allowable (without waiver authority) maintenance assistance payments on behalf of children participating in the approved and operational title IV-E demonstration project where maintenance assistance payments are considered as part of the capped allocation design CNL. These costs are to be used in the cost neutrality calculation. Furthermore, the Federal share of any child support collections made on behalf of the children whose maintenance payments are reported on this line must be reported in Part 1, line 3. Any amount reported on this line should not be reported in Part 1, Lines 1-15 for Foster Care, Lines 20-24 for Adoption Assistance or Lines 29-33 & 34b for Guardianship Assistance.

For a Foster Care project, these costs may only cover the items classified as title IV-E maintenance payments in Section 475(4)(A) of the Act for children determined as title IV-E eligible and form CB-496, Part 1 instructions for Lines 1a, 1b, 1c, 2a and 2b. Costs for title IV-E maintenance payments on behalf of a child placed with a parent residing in a licensed residential family-based treatment facility for substance abuse (see Substance Abuse Treatment Facility Placements in the Part 1 definitions section) are not subject to a demonstration project CNL and must, therefore, be reported in Part 1 on Line 1d rather than on this line. Title IV-E maintenance assistance payments made through a Tribal-State title IV-E agreement may also not be subject to a demonstration project CNL (unless specified as such in the approved terms and conditions) and must, in that instance, be reported in Part 1 on Lines 2a or 2b rather than on this line.

For an Adoption Assistance demonstration project, these costs are subject to the limitation specified in Section 473(a)(3) of the Act for children determined as title IV-E eligible and form CB-496, Part 1 instructions for Lines 20 and 21.

For a Guardianship Assistance demonstration project, these costs are subject to the limitation specified in Section 473(d)(2) of the Act for children determined as title IV-E eligible and form CB-496, Part 1 instructions for Lines 29 and 30.

Additional project costs (i.e. other than title IV-E assistance payments) for these or other children are reported elsewhere in this Part.

(Enter amounts directly in Columns A, C, D and G for Capped Allocation Design projects. Columns B, E, F and H are automatically calculated to display Federal share or totals.)

Line 5b. Title IV-E In-Placement Administration (Excluding Candidate) Operations (50 Percent FFP Rate) – Costs reported on this line are title IV-E allowable (without waiver authority) amounts spent on behalf of placed children participating in the approved and operational title IV-E demonstration project where in-placement administration is considered as part of the capped allocation design CNL. These costs may only cover the items classified as title IV-E in-placement administration in accordance with Federal regulations at 45 CFR 1356.60(c) and form CB-496, Part 1 instructions for Lines 5–8 (Foster Care), Lines 22 and 23 (Adoption Assistance) or Lines 31 and 32 (Guardianship Assistance). Additional project costs for these or other children are reported elsewhere in this Part. Any amount reported on this line should not be reported in Part 1, Lines 1-15 for Foster Care, Lines 20-24 for Adoption Assistance or Lines 29-34b for Guardianship Assistance. These expenditures are to be used in the cost neutrality calculation. This line should remain blank if costs in the in-placement administration funding category are not subject to a CNL under the reported project.

(Enter amounts directly in Columns A, C and G for Capped Allocation Design projects where and to the extent that in-placement (Foster Care) or agency/non-recurring costs (Adoption or Guardianship Assistance) administrative costs are considered in the CNL. Columns B, D, E, F and H are automatically calculated to display Federal share or totals.)

Line 5c. Title IV-E Candidate Administration Operations (50 Percent FFP Rate) – Costs reported on this line are title IV-E allowable (without waiver authority) amounts spent on behalf of children determined as title IV-E candidates participating in the approved and operational title IV-E demonstration project where candidate administration is considered as part of the capped allocation design CNL. These costs may only cover the items classified as title IV-E candidate pre-placement administration in accordance with Federal regulations at 45 CFR 1356.60(c) and form CB-496, Part 1 instructions for Line 9. Additional project costs for these or other children are reported elsewhere in this Part. Any amount reported on this line should not be reported in Part 1, Lines 1-15 for Foster Care. These expenditures are to be used in the cost neutrality calculation. This line should remain blank if costs in the candidate administration funding category are not subject to a CNL under the reported project.

(Enter amounts directly in Columns A, C and G for Capped Allocation Design projects where Foster Care candidate administrative costs are considered in the CNL. Columns B, D, E, F and H are automatically calculated to display Federal share or totals.)

Line 5d. Title IV-E CCWIS Operational Costs Operations (50 Percent FFP Rate) – Costs reported on this line are title IV-E allowable (without waiver authority) CCWIS operations amounts spent on behalf of children participating in the approved and operational title IV-E demonstration project where CCWIS operational costs are considered as part of the capped allocation design CNL. These costs may only cover the items classified as title IV-E CCWIS operations in accordance with Federal regulations at 45 CFR 1355.57 and form CB-496, Part 1 instructions for Lines 12a and 12b. Additional project costs for these or other children are reported elsewhere in this Part. Any amount reported on this line should not be reported in Part 1, Lines 1-15 for Foster Care. These expenditures are to be used in the cost neutrality calculation. This line should remain blank if costs in the CCWIS operational funding category are not subject to a CNL under the reported project.

(Enter amounts directly in Columns A, C and G for Capped Allocation Design projects where Foster Care CCWIS operational costs are considered in the CNL. Columns B, D, E, F and H are automatically calculated to display Federal share or totals.)

Line 5e. Title IV-E Staff/Provider and Professional Partner Training Operations (75 Percent FFP Rate) – Costs reported on this line are title IV-E allowable (without waiver authority) training amounts spent on behalf of children participating in the approved and operational title IV-E demonstration project where training is considered as part of the capped allocation design CNL. These costs may only cover the items classified as title IV-E training in accordance with Federal regulations at 45 CFR 1356.60(b) and form CB-496, Part 1 instructions for Line 15 (Foster Care), Line 24 (Adoption Assistance) or Line 33 (Guardianship Assistance). Additional project costs for these or other children are reported elsewhere in this Part. Any amount reported on this line should not be reported in Part 1, Lines 1-15 for Foster Care or Lines 20-24 for Adoption Assistance. These expenditures are to be used in the cost neutrality calculation. This line should remain blank if costs in the training funding category are not subject to a CNL under the reported project.

(Enter amounts directly in Columns A, C and G for Capped Allocation Design projects where training costs are considered in the CNL. Columns B, D, E, F and H are automatically calculated to display Federal share or totals.)

Line 6a. FMAP Rate – Project Intervention and Other Waiver-Based Expenditures - The amounts reported on this line can include: 1) expenditures for project interventions; 2) otherwise not claimed title IV-B/IV-E eligible activities that are in accordance with the approved waiver demonstration terms and conditions; or 3) amounts applied from the FMAP rate expenditures holding account (Line 22a). If holding account amounts accumulated on previous Part 3 reports are included on this line, an appropriate deduction to Line 22a should appear on this and future quarterly demonstration project reports using the form CB-496, Part 3. The title IV-E agency should also maintain supporting documentation establishing how all amounts were expended.

Line 6a provides for reporting of costs at the FMAP rate for all other approved project operations fundable up to the available amount, excluding those reportable in Section A as title IV-E allowable (without a waiver) and as project developmental or evaluation costs. If the project is also assessed for cost neutrality purposes based on title IV-E administrative/CCWIS and/or training costs, other options to report these costs are available on Lines 6b (at the 50% FFP rate or 6c (at the 75% FFP rate).

The title IV-E agency should first determine the availability of funding on Line 6a through “test” completion of Section B (Cost Neutrality). This can be done by following the Section B instructions listed below. However, when completing Line 18a, the title IV-E agency should enter only cumulatively funded amounts plus currently reported amounts on Line 5a. The title IV-E agency will then be able to identify in Section C (Project Savings/Unused Allocations) any amount available for expenditure at the FMAP rate on Line 24a. It can then report any claims as appropriate on Line 6a and include those amounts on Line 18a (per below instructions). Any claims filed on Line 6a which exceed the calculated cost neutrality limit will automatically be identified as part of the FMAP rate holding account (Line 22a) on this quarter’s report.

Total computable amounts are reported in Column A if expended in the reporting quarter or in Column C if expended in a previous quarter. Using the applicable FMAP rate, the appropriate level of title IV-E agency match should be used for all expenditures of available demonstration project savings reported on this line. Columns E and F serve as an automatic check to assure that amounts are not reported in Columns A-D unless calculated as available.

(Enter amounts directly in Columns A, C, D and G for Capped Allocation Design projects. Columns B, E, F and H are automatically calculated to display Federal share or totals.)

Line 6b. 50 Percent FFP Rate – Project Intervention and Other Waiver-Based Expenditures - The amounts reported on this line can include: 1) expenditures for project interventions; 2) otherwise not claimed title IV-B/IV-E eligible activities that are in accordance with the approved waiver demonstration terms and conditions; or 3) amounts applied from the 50 percent FFP rate expenditures holding account (Line 22b). If holding account amounts accumulated on previous Part 3 reports are included on this line, an appropriate deduction to Line 22b should appear on this and future quarterly demonstration project (form CB-496, Part 3) reports. The title IV-E agency should also maintain supporting documentation establishing how all amounts were expended.

Line 6b provides for reporting at the 50 percent FFP rate of costs for all other approved project operations (fundable up to the available amount) excluding those reportable in Section A as title IV-E allowable (without a waiver) and as project developmental or evaluation costs. If the project is also assessed for cost neutrality purposes based on title IV-E maintenance payments and/or training costs, other options to report these costs are available on Lines 6a (at the FMAP rate) or 6c (at the 75% FFP rate).

The title IV-E agency should first determine the availability of funding on Line 6b through “test” completion of Section B (Cost Neutrality). This can be done by following the Section B instructions listed below. However, when completing line 18b, enter only cumulatively funded amounts plus currently reported amounts on Line 5b, 5c, and 5d (if S/TACWIS or CCWIS is included for cost neutrality). The title IV-E agency will then be able to identify in Section C (Project Savings/Unused Allocations) any amount available for expenditure at the 50 percent FFP rate on Line 24b. It can then report any claims as appropriate on Line 6b and include those amounts on line 18b (per below instructions). Any claims filed on line 6b that exceed the calculated cost neutrality limit will automatically be identified as part of the 50 percent FFP rate holding account (Line 22b) on this quarter’s report.

Total computable amounts are reported in Column A if expended in the reporting quarter or in Column C if expended in a previous quarter. Using the 50 percent FFP rate, the appropriate level of IV-E agency should be used for all expenditures of available demonstration project savings reported on this line. Columns E and F serve as an automatic check to assure that amounts are not reported in Columns A-D unless calculated as available.

(Enter amounts directly in Columns A, C and G for Capped Allocation Design projects where 50 percent FFP rate funding categories are considered in the CNL. Columns B, D, E, F and H are automatically calculated to display Federal share or totals.)

Line 6c. 75 Percent FFP Rate – Project Intervention and Other Waiver Based Expenditures - The amounts reported on this line can include: 1) expenditures for project interventions; 2) otherwise not claimed title IV-B/IV-E eligible activities that are in accordance with the approved waiver demonstration terms and conditions; or 3) amounts applied from the 75 percent FFP rate expenditures holding account (Line 22c). If holding account amounts accumulated on previous Part 3 reports are included on this line, an appropriate deduction to Line 22c should appear on this and future quarterly demonstration project reports using the form CB-496, Part 3. The IV-E agency should also maintain supporting documentation establishing how all amounts were expended.

Line 6c thus provides for reporting costs at the 75 percent FFP rate for all other approved project operations fundable up to the available amount, excluding those reportable in Section A as title IV-E allowable (without a waiver) and as project developmental or evaluation costs. If the project is also assessed for cost neutrality purposes based on title IV-E maintenance payments and/or administrative/S/TACWIS or CCWIS costs, other options to report these costs are available on Lines 6a (at the FMAP rate) or 6b (at the 50% FFP rate).

The title IV-E agency should first determine the availability of funding on Line 6c through “test” completion of Section B (Cost Neutrality). This can be done by following the Section B instructions listed below. However, when completing Line 18c, enter only cumulatively funded amounts plus currently reported amounts on line 5e. The title IV-E agency will then be able to identify in Section C (Project Savings/Unused Allocations) any amount available for expenditure at the 75 percent FFP rate on Line 24c. It can then report any claims as appropriate on Line 6c and include those amounts on Line 18c, per the instructions below. Any claims filed on Line 6c which exceed the calculated cost neutrality limit will automatically be identified as part of the 75 percent FFP rate holding account (line 22c) on this quarter’s report.

Total computable amounts are reported in Column A if expended in the reporting quarter or in Column C if expended in a previous quarter. Using the 75 percent FPP rate, the appropriate level of title IV-E agency match should be used for all expenditures of available demonstration project savings reported on this line. Columns E and F serve as an automatic check to assure that amounts are not reported in Columns A-D unless calculated as available.

(Enter amounts directly in Columns A, C and G for Capped Allocation Design projects where 75 percent FFP rate funding categories are considered in the CNL. Columns B, D, E, F and H are automatically calculated to display Federal share or totals.)

Line 7. Project Developmental Costs (50 Percent FFP Rate) - These are the costs associated with the development of the demonstration proposal. This includes costs for the performance of project activities undertaken before implementation of the demonstration project in accordance with the approved waiver terms and conditions and the title IV-E agency's approved developmental cost plan. These demonstration costs are treated as project administration at the 50 percent rate of FFP and are not subject to the cost-neutrality calculation. Developmental costs must cease prior to the date the project is deemed implemented (operational) anywhere in the State or the Tribe’s service area.

(Enter amounts directly in Columns A, C and G on Line 7 for Capped Allocation Design projects. Columns B, D, E, F and H are automatically calculated to display Federal share or totals.)

Line 8. Project Evaluation Costs (50 Percent FFP Rate) - These are the costs associated with the performance of a project evaluation in accordance with the approved waiver terms and conditions and the IV-E agency's approved evaluation plan. These demonstration costs are treated as project administration at the 50 percent rate of FFP and are not subject to the cost-neutrality calculation. Evaluation costs may begin with the quarter when the project is implemented (operational) anywhere in the IV-E agency and might extend for a period beyond the completion of the demonstration project. In this case, Part 3 must be completed to identify such costs even though there may be no other demonstration expenditures or need for a cost-neutrality calculation. Pre-implementation approved evaluation planning and preparation costs are reported as part of developmental costs.

(Enter amounts directly in Columns A, C and G on Line 8 for Capped Allocation Design projects. Columns B, D, E, F and H are automatically calculated to display Federal share or totals.)

Line 17a. Maintenance Payments (FMAP Rate) - Cumulative Title IV-E Capped Allocation (CA) - The amount to be entered in Columns E and G (Total Computable) should result from maintenance payment calculations in accordance with the approved terms and conditions on cost-neutrality for each title IV-E agency's project. This represents the maximum amount of cost at the applicable FMAP rate available through the appropriate reporting quarter for reimbursement of allowable demonstration project operational expenditures (Column E) and future estimates (Column G).

The cumulative capped allocation must be the amount calculated through the applicable reporting quarter as per the capped allocation payments table in the approved project terms and conditions or an approved fixed schedule of payments through a separate spreadsheet. The resulting totals are entered on this line.

(Enter amounts directly in Columns E and G for Capped Allocation projects. The Column G amount should equal the Column E amount plus the title IV-E agency's determination of the additional capped allocation amount projected for the two subsequent quarters following the current quarter, which includes the quarter during which this claim is being filed and the quarter for next quarter estimates.)

Line 17b. Administration and CCWIS Costs (50 Percent FFP Rate) - Cumulative Title IV-E Capped Allocation (CA) - The amount to be entered in Columns E and G (Total Computable) should result from the sum of any administrative costs or CCWIS operational costs subject to inclusion in the capped allocation in accordance with the approved terms and conditions on cost-neutrality for each title IV-E agency's project. This represents the maximum amount of cost at the 50 percent FFP rate available through this reporting period for reimbursement of allowable demonstration project operational expenditures (Column E) and future estimates (Column G). It should be noted that not all projects will include administrative or CCWIS operational costs within the capped allocation. In these instances, such costs must not be reported on this line.

The cumulative capped allocation must be the amount calculated through the applicable reporting quarter as per the approved project terms and conditions or an approved payment schedule through a separate spreadsheet. The resulting totals are entered on this line.

(Enter amounts directly in Columns E and G for Capped Allocation projects where 50 percent FFP rate funding categories are considered in the CNL. The Column G amount should equal the Column E amount plus the title IV-E agency's determination of the additional capped allocation amount projected for the two subsequent quarters following the current quarter, which includes the quarter during which this claim is being filed and the quarter for next quarter estimates.)

Line 17c. Training Costs (75 Percent FFP Rate) - Cumulative Title IV-E Capped Allocation (CA) - The amount to be entered in Columns E and G (Total Computable) should result from the sum of any staff and provider training or professional partner training costs subject to inclusion in the capped allocation in accordance with the approved terms and conditions on cost-neutrality for each IV-E agency's project. This represents the maximum amount of cost at the 75 percent FFP rate available through this reporting period for reimbursement of allowable demonstration project operational expenditures (Column E) and future estimates (Column G). It should be noted that not all projects will include training costs within the capped allocation. In these instances, such costs must not be reported on this line.

The cumulative capped allocation must be the amount calculated through the applicable reporting quarter as per the approved project terms and conditions an approved payment schedule through a separate spreadsheet. The resulting totals are entered on this line.

(Enter amounts directly in Columns E and G for Capped Allocation projects where 75 percent FFP rate funding categories are considered in the CNL. The Column G amount should equal the Column E amount plus the title IV-E agency's determination of the additional capped allocation amount projected for the two subsequent quarters following the current quarter, which includes the quarter during which this claim is being filed and the quarter for next quarter estimates.)

Line 18a. FMAP Rate - Currently Reported and Cumulatively Funded Demonstration Operational Costs - The amount reported represents all operational costs reported over the life of the project as title IV-E maintenance payments or other costs subject to the FMAP rate, minus any previously reported amounts that were determined as not fundable.

The Column E amount consists of the total of Lines 5a and 6a above and the total of Line 18a minus Line 21a from the previous quarter's demonstration Project form CB-496, Part 3 (all amounts taken from Column E). The title IV-E agency must adjust this figure to exclude any expenditure amount not reimbursable because it was disallowed. If a disallowance action is appealed, the title IV-E agency should not reduce the Line 18a total if it decides to retain the funds pending a decision. In addition, should the title IV-E agency prevail in the appeal, a further adjustment to this line may be necessary.

The Column G entry is the sum of: Step 1) Column E amount minus any Line 21a Column E entries plus the Column G entries on Lines 5a and 6a. Step 2) Add the total of Column G, Lines 5a and 6a minus any Line 21a Column G entries from the previous quarter’s form CB-496, Part 3 report to account for the one additional quarter funded through grant award authority, but not yet subject to expenditure reporting.

(Enter amounts directly in Columns E and G for Capped Allocation projects. These entries are determined from amounts reported on this and the prior quarter’s Part 3 submissions as noted above).

Line 18b. 50 Percent FFP Rate - Currently Reported and Cumulatively Funded Demonstration Operational Costs - The amount reported represents all operational costs reported over the life of the project as title IV-E administration, CCWIS costs or other costs subject to the 50 percent FFP rate minus any previously reported amounts that were not fundable.

The Column E amount consists of the total of Lines 5b, 5c, 5d and 6b above and the total of Line 18b minus Line 21b from the previous quarter's demonstration project form CB-496, Part 3 report (all amounts taken from Column E). The title IV-E agency must adjust this figure to exclude any expenditure amount not reimbursable because it was disallowed. If a disallowance action is appealed, the title IV-E agency should not reduce the line 18b total if it decides to retain the funds pending a decision. In addition, should the title IV-E agency prevail in the appeal, a further adjustment to this line may be necessary.

The Column G entry is the sum of: Step 1) Calculation: Column E amount minus any Line 21b Column E entries plus the sum of Column G entries on Lines 5b, 5c, 5d and 6b. Step 2) Manual Addition: Add the sum of Column G Lines 5b, 5c, 5d and 6b, minus Line 21b Column G entries from the previous quarter’s form CB-496, Part 3 report to account for the one additional quarter funded through grant award authority, but not yet subject to expenditure reporting.

(Enter amounts directly in Columns E and G for Capped Allocation projects where 50 percent FFP rate funding categories are considered in the CNL. These entries are determined from amounts reported on this and the prior quarter’s Part 3 submissions as noted above).

Line 18c. 75 Percent FFP Rate - Currently Reported and Cumulatively Funded Demonstration Operational Costs - The amount reported represents all operational costs reported over the life of the project as title IV-E training or other costs subject to the 75 percent FFP rate, minus any previously reported amounts that were not fundable.

The Column E amount consists of the total of Lines 5e and 6c above and the total of Line 18c minus Line 21c from the previous quarter's demonstration project form CB-496, Part 3 report (all amounts taken from Column E). The title IV-E agency must adjust this figure to exclude any expenditure amount not reimbursable because it was disallowed. If a disallowance action is appealed, the title IV-E agency should not reduce the Line 18c total if it decides to retain the funds pending a decision. In addition, should the title IV-E agency prevail in the appeal, a further adjustment to this line may be necessary.

The Column G entry is the sum of: Step 1) Calculation: Column E amount minus any Line 21c Column E entries plus the Column G entries on Lines 5e and 6c. Step 2) Manual Addition: Add the total of Column G Lines 5e and 6c minus Line 21c Column G entries from the previous quarter’s form CB-496, Part 3 report to account for the one additional quarter funded through grant award authority, but not yet subject to expenditure reporting.

(Enter amounts directly in Columns E and G for Capped Allocation projects where 75 percent FFP rate funding categories are considered in the CNL. These entries are determined from amounts reported on this and the prior quarter’s Part 3 submissions as noted above).

Line 19a. FMAP Rate - Cumulative Demonstration Operational Costs in Excess of Capped Allocation – The amount reported represents any currently reported or previously funded project operational costs at the FMAP rate that exceed the cumulative Capped Allocation identified on this report. This line is automatically calculated based on equivalent column entries on Lines 17a and 18a. The formula applied is as follows: Line 18a minus Line 17a. Amounts in Column E are treated as zero (0) if the result is a negative number. A positive number is recorded as calculated. The result of these steps is entered in Columns E and G of this line and constitutes the cumulative amount in excess of the Capped Allocation for the FMAP rate funding category. It should be noted that if this total exceeds the total reported on Lines 5a plus 6a, a portion of previously funded costs are now also in excess of the calculated Capped Allocation. No reconciliation will be made for this potential funding overage until the quarter in which claiming for project operations is completed.

(No entries are required. All columns are calculated for Capped Allocation projects as noted above.)

Line 19b. 50 Percent FFP Rate - Cumulative Demonstration Operational Costs in Excess of Capped Allocation – The amount reported represents any currently reported or previously funded project operational costs at the 50 percent FFP rate that exceed the cumulative Capped Allocation identified on this report. This line is automatically calculated based on entries on Lines 17b and 18b. The formula applied is the following: Line 18b minus Line 17b. Amounts in Column E are treated as zero (0) if the result is a negative number. A positive number is recorded as calculated. The result of these steps, including negative amounts, is entered in Columns E and G of this line and constitutes the cumulative amount in excess of Capped Allocation for the 50 percent FFP rate funding category. It should be noted that if this total exceeds the total reported on Lines 5b, 5c, 5d plus 6b, a portion of previously funded costs are now also in excess of the calculated Capped Allocation. No reconciliation will be made for this potential funding overage until the quarter in which claiming for project operations is completed.

(No entries are required. All columns are calculated for Capped Allocation projects as noted above.)

Line 19c. 75 Percent FFP Rate - Cumulative Demonstration Operational Costs in Excess of Capped Allocation – The amount reported represents any currently reported or previously funded project operational costs at the 75 percent FFP rate that exceed the cumulative Capped Allocation identified on this report. This line is automatically calculated based on entries on Lines 17c and 18c. The formula applied is the following: Line 18c minus Line 17c. Amounts in Column E are treated as zero (0) if the result is a negative number. A positive number is recorded as calculated. The result of these steps (including negative amounts) is entered in Columns E and G of this line and constitutes the cumulative amount in excess of Capped Allocation for the 75 percent FFP rate funding category. It should be noted that if this total exceeds the total reported on Lines 5c plus 6c, a portion of previously funded costs are now also in excess of the calculated Capped Allocation. No reconciliation will be made for this potential funding overage until the quarter in which claiming for project operations is completed.

(No entries are required. All columns are calculated for Capped Allocation projects as noted above.)

Line 20a. FMAP Rate - Fundable Portion of Total Quarterly Project Operational Costs - Amounts are initially calculated in Columns E and G only. The amount entered is equal to the same column amount on Line 5a plus 6a minus Line 21a. This is the maximum amount of the reported costs subject to Federal funding as of the date reported. If these expenditure/estimate amounts match the amounts reported in the equivalent columns on Line 5a plus 6a, the remaining Line 20a columns are automatically completed by copying data from Line 5a plus 6a. However, if there is a difference between these totals, the resulting Line 20a total computable expenditure amount is automatically apportioned between current and prior quarter amounts in accordance with the relative percentages attributable to each category on Lines 5a plus 6a, Columns A and C. The amounts entered in the Federal share columns (Columns B, D, F and H) are also automatically calculated by dividing the total computable amount (Columns A, C and G) by the calculated FFP rate. The calculated FFP rate is equal to the Line 5a plus 6a Federal share amount in the same column divided by the associated total computable column (e.g., Column B/Column A).

(No entries are required. All columns are calculated for Capped Allocation projects as noted above.)

Line 20b. 50 Percent FFP Rate - Fundable Portion of Total Quarterly Project Operational Costs - Amounts are initially calculated in Columns E and G only. The amount entered is equal to the sum of the same column amount on Lines 5b, 5c, 5d and 6b, minus line 21b. This is the maximum amount of the reported costs subject to Federal funding as of the date reported. If these expenditure/estimate amounts match the amounts reported in the equivalent columns on Lines 5b, 5c, 5d and 6b, the remaining Line 20b columns are automatically completed by copying data from the sum of Lines 5b, 5c, 5d and 6b. However, if there is a difference between these totals, the resulting Line 20b total computable expenditure amount is automatically apportioned between current and prior quarter amounts in accordance with the relative percentages attributable to each category on Lines 5b, 5c, 5d and 6b, Columns A and C. The amounts entered in the Federal share columns (Columns B, D, F and H) are also automatically calculated by dividing the total computable amount (Columns A, C and G) by the calculated FFP rate. The calculated FFP rate is equal to the sum of Lines 5b, 5c, 5d and 6b Federal share amount in the same column divided by the associated total computable column (e.g., Column B/Column A).

(No entries are required. All columns are calculated for Capped Allocation projects as noted above.)

Line 20c. 75 Percent FFP Rate - Fundable Portion of Total Quarterly Project Operational Costs - Amounts are initially calculated in Columns E and G only. The amount entered is equal to the same column amount on Line 5e plus 6c minus Line 21c. This is the maximum amount of the reported costs subject to Federal funding as of the date reported. If these expenditure/estimate amounts match the amounts reported in the equivalent columns on Line 5e plus 6c, the remaining Line 20c columns are automatically completed by copying data from Line 5e plus Line 6c. However, if there is a difference between these totals, the resulting Line 20c total computable expenditure amount is automatically apportioned between current and prior quarter amounts in accordance with the relative percentages attributable to each category on Lines 5e plus 6c, Columns A and C. The amounts entered in the Federal share columns (Columns B, D, F and H) are also automatically calculated by dividing the total computable amount (Columns A, C and G) by the calculated FFP. The calculated FFP rate is equal to the Line 5e plus 6c Federal share amount in the same column divided by the associated total computable column (e.g., Column B/Column A).

(No entries are required. All columns are calculated for Capped Allocation projects as noted above.)

Line 21a. FMAP Rate - Non-Fundable Portion of Total Quarterly Project Operational Costs - This line represents the amount of any reported FMAP rate operational cost claims that exceed the Capped Allocation calculation. Amounts are initially calculated in Columns E and G only. The amount entered is determined by comparing the Line 5a plus Line 6a subtotal to the line 19a entry in the same column. If this subtotal exceeds or equals the line 19a entry, the full amount of the line 19a entry is entered in the same column on line 21a. If the calculated subtotal is less than the line 19a entry in the same column, the formula used is as follows: [line 19a – (line 19a – line 5a – line 6a)]. Special Note: If the sum of the column E amounts on Lines 5a plus 6a results in a negative number, no further calculations are needed and a zero is entered in column F on this line. This step is necessary to permit acceptance of net decreasing adjustments in a funding category without applying a cost neutrality related impact. The result of this calculation is the portion (if any) of the reported project operational costs subject to Federal funding at the FMAP rate that exceed the calculated Capped Allocation and are thus non-fundable.

If the calculated Columns E and G amounts are equal to zero, the remaining Line 21a columns are automatically completed by entering zeroes. However, if Column E has a calculated entry greater than zero, the resulting Line 21a total computable expenditure amount is automatically apportioned between current and prior quarter amounts in accordance with the relative percentages attributable to each category on Lines 5a and 6a, Columns A and C. The amounts entered in the Federal share columns (Columns B, D, F and H) are also automatically calculated by multiplying the total computable amount (Columns A, C and G) by the calculated FMAP rate. The calculated FMAP rate is equal to the Line 5a plus Line 6a Federal share amount in the same column divided by the associated total computable column (e.g., Column B/Column A).

(No entries are required. All columns are calculated for Capped Allocation projects as noted above.)

Line 21b. 50 Percent FFP Rate - Non-Fundable Portion of Total Quarterly Project Operational Costs - This line represents the amount of any reported 50 percent FFP rate operational cost claims that exceed the Capped Allocation calculation. Amounts are initially calculated in Columns E and G only. The amount entered is determined by comparing the Lines 5b, 5c, 5d and 6b subtotal to the line 19b entry in the same column. If this subtotal exceeds or equals the line 19b entry, the full amount of the line 19b entry is entered in the same column on line 21b. If the calculated subtotal is less than the line 19a entry in the same column, the formula used is as follows: [line 19b – (line 19b – line 5b – line 5c – line 5d – line 6b)]. Special Note: If the sum of the column E amounts on Lines 5b-5d plus 6a results in a negative number, no further calculations are needed and a zero is entered in column F on this line. This step is necessary to permit acceptance of net decreasing adjustments in a funding category without applying a cost neutrality related impact. The result of this calculation is the portion (if any) of the reported project operational costs subject to Federal funding at the 50 percent FFP rate that exceed the calculated Capped Allocation and are thus non-fundable.

If the calculated Columns E and G amounts are equal to zero, the remaining Line 21b columns are automatically completed by entering zeroes. However, if Column E has a calculated entry greater than zero, the resulting Line 21b total computable expenditure amount is automatically apportioned between current and prior quarter amounts in accordance with the relative percentages attributable to each category on Lines 5b, 5c, 5d and 6b, Columns A and C. The amounts entered in the Federal share columns (Columns B, D, F and H) are also automatically calculated by multiplying the total computable amount (Columns A, C and G) by the 50 percent FFP rate.

(No entries are required. All columns are calculated for Capped Allocation projects as noted above.)

Line 21c. 75 Percent FFP Rate - Non-Fundable Portion of Total Quarterly Project Operational Costs - This line represents the amount of any reported 75 percent FFP rate operational cost claims that exceed the Capped Allocation calculation. Amounts are initially calculated in Columns E and G only. The amount entered is determined by comparing the Line 5e plus Line 6c subtotal to the line 19c entry in the same column. If this subtotal exceeds or equals the line 19c entry, the full amount of the line 19c entry is entered in the same column on line 21c. If the calculated subtotal is less than the line 19c entry in the same column, the formula used is as follows: [line 19c – (line 19c – line 5e – line 6c)]. Special Note: If the sum of the column F amounts on Lines 5e plus 6c results in a negative number, no further calculations are needed and a zero is entered in column E on this line. This step is necessary to permit acceptance of net decreasing adjustments in a funding category without applying a cost neutrality related impact. This is the portion (if any) of the reported project operational costs subject to Federal funding at the 50 percent FFP rate that exceed the calculated Capped Allocation and are thus non-fundable.

If the calculated Columns E and G amounts are equal to zero, the remaining Line 21c columns are automatically completed by entering zeroes. If, however, Column E has a calculated entry greater than zero, the resulting Line 21c total computable expenditure amount is automatically apportioned between current and prior quarter amounts in accordance with the relative percentages attributable to each category on Lines 5e and 6c, Columns A and C. The amounts entered in the Federal share columns (Columns B, D, F and H) are also automatically calculated by multiplying the total computable amount (Columns A, C and G) by the 75 percent FFP rate.

(No entries are required. All columns are calculated for Capped Allocation projects as noted above.)

Line 22a. FMAP Rate - Cumulative Holding Account (Unfunded Operational Costs In Excess of Capped Allocation) - A cumulative holding account balance for the FMAP rate Capped Allocation calculation must be established to assure that these reported expenditures are properly tracked. Although this amount will sometimes be equal to the Line 19a total, it can differ based on prior project operations. An entry is calculated only in Column E. The amount reported is the cumulative total current balance of the holding account for this funding rate. That number is equal to the Line 21a of the current report plus Line 22a from the previous quarter's demonstration Project, CB-496 Part 3 report, minus any adjustments.

Adjustments to the holding account can result from either a determination that an amount is no longer reimbursable or a movement of previously reported holding account amounts to Line 6a (demonstration project intervention and other waiver-based expenditures). When unused portions of a Capped Allocation are identified, the title IV-E agency should consider using these funds first as reimbursement of holding account expenditures. Supporting documentation should be maintained by the title IV-E agency to demonstrate the results of this analysis of the holding account amount each quarter.

Amounts should not ordinarily remain in the holding account beyond the last quarter during which the associated waiver demonstration project is operational in accordance with the approved terms and conditions. The holding account entry may continue to be reported for several quarters after the completion of the demonstration project operations if the title IV-E agency intends to report prior quarter adjustments (for periods when the project was in operation) to demonstration expenditures. However, Federal regulations at 45 CFR 95.7, impose time constraints for the reporting of increasing adjustment claims. Any amounts pending beyond this limit should be removed from the holding account as no longer subject to reimbursement. It should also be noted that in accordance with the Cash Management Improvement Act, title IV-E funds granted in a Federal fiscal year (FFY) remain available for a total of five FFYs and are then recovered as part of a close-out if not reported as expended.

(Enter an amount, if any, for Capped Allocation projects in Column E only. This entry is derived both from data reported elsewhere on this submission and any entry on Line 16a from the previous quarter’s report as noted above.)

Line 22b. 50 Percent FFP Rate - Cumulative Holding Account (Unfunded Operational Costs In Excess of Capped Allocation) - A cumulative holding account balance for the 50 percent FFP rate Capped Allocation calculation must be established to assure that these reported expenditures are properly tracked. Although this amount will sometimes be equal to the Line 19b total, it can differ based on prior project operations. An entry is calculated only in Column E. The amount reported is the cumulative total current balance of the holding account for this funding rate. That number is equal to the Line 21b of the current report plus Line 22b from the previous quarter's demonstration project, form CB-496, Part 3 report, minus any adjustments.

Adjustments to the holding account can result from either a determination that an amount is no longer reimbursable or a movement of previously reported holding account amounts to Line 6b project intervention and other waiver based expenditures). When unused portions of a capped allocation are identified, the title IV-E agency should consider using these funds first as reimbursement of holding account expenditures. Supporting documentation should be maintained by the title IV-E agency to demonstrate the results of this analysis of the holding account amount each quarter.

Amounts should not ordinarily remain in the holding account beyond the last quarter during which the associated waiver demonstration project is operational in accordance with the approved terms and conditions. The holding account entry may continue to be reported for several quarters after the completion of the demonstration operations if the title IV-E agency intends to report prior quarter adjustments (for periods when the project was in operation) to demonstration expenditures. However, Federal regulations at 45 CFR 95.7, impose time constraints for the reporting of increasing adjustment claims. Any amounts pending beyond this limit should be removed from the holding account as no longer subject to reimbursement. It should also be noted that in accordance with the Cash Management Improvement Act, title IV-E funds granted in a FFY remain available for a total of five FFYs and are then recovered as part of a close-out if not reported as expended.

(Enter an amount, if any, for Capped Allocation projects in Column E only. This entry is derived both from data reported elsewhere on this submission and any entry on Line 16a from the previous quarter’s report as noted above.)

Line 22c. 75 Percent FFP Rate - Cumulative Holding Account (Unfunded Operational Costs In Excess of Capped Allocation) - A cumulative holding account balance for the 75 percent FFP rate Capped Allocation calculation must be established to assure that these reported expenditures are properly tracked. Although this amount will sometimes be equal to the Line 19c total, it can differ based on prior project operations. An entry is calculated only in Column E. The amount reported is the cumulative total current balance of the holding account for this funding rate. That number is equal to the Line 21c of the current report, plus Line 22c from the previous quarter's demonstration projects, form CB-496, Part 3 report, minus any adjustments.

Adjustments to the holding account can result from either a determination that an amount is no longer reimbursable or a movement of previously reported holding account amounts to Line 6c (project intervention and other waiver based expenditures). When unused portions of a Capped Allocation are identified, the title IV-E agency should consider using these funds first as reimbursement of holding account expenditures. Supporting documentation should be maintained by the title IV-E agency to demonstrate the results of this analysis of the holding account amount each quarter.

Amounts should not ordinarily remain in the holding account beyond the last quarter during which the associated waiver demonstration project is operational in accordance with the approved terms and conditions. The holding account entry may continue to be reported for several quarters after the completion of the demonstration operations if the title IV-E agency intends to report prior quarter adjustments (for periods when the project was in operation) to demonstration expenditures. However, Federal regulations at 45 CFR 95.7 impose time constraints for the reporting of increasing adjustment claims. Any amounts pending beyond this limit should be removed from the holding account as no longer subject to reimbursement. It should also be noted that in accordance with the Cash Management Improvement Act, title IV-E funds granted in a FFY remain available for a total of five FFYs and are then recovered as part of a close-out if not reported as expended.

(Enter an amount, if any, for Capped Allocation projects in Column E only. This entry is derived both from data reported elsewhere on this submission and any entry on Line 16a from the previous quarter’s report as noted above.)

Line 24a. FMAP Rate - Cumulative Title IV-E Capped Allocation Remaining Available for Expenditure - This line represents the amount of the Capped Allocation during the life of the demonstration project now remaining available for expenditure with Federal reimbursement at the FMAP rate. It consists of the total over the life of the project’s operations by which the FMAP rate Capped Allocation exceeds currently reported and previously funded FMAP rate expenditures. The calculation includes Line 17a minus Line 18a. This amount is reported as total computable only in Column E. An entry of zero (0) is made unless the result of the calculation is a positive number. For informational purposes only, a special Column H entry is calculated to identify the estimated title IV-E agency share that would be required to be expended to claim the full amount shown in Column E along with a Column F Federal share amount. These amounts are labeled as “estimated” since the unused allocation may actually be expended in a subsequent FFY where the matching rate may differ from that applied to reported current quarter claims on this report.

(No entries are required. All columns are calculated for Capped Allocation projects as noted above.)

Line 24b. 50 Percent FFP Rate - Cumulative Title IV-E Capped Allocation Remaining Available for Expenditure - This line represents the amount of the Capped Allocation during the life of the demonstration project now remaining available for expenditure with Federal reimbursement at the 50 percent FFP rate. It consists of the total over the life of the project’s operations by which the 50 percent FFP rate Capped Allocation exceeds currently reported and previously funded 50 percent FFP rate expenditures. The calculation includes Line 17b minus Line 18b. This amount is reported as total computable only in Column E. An entry of zero (0) is made unless the result of the calculation is a positive number. For informational purposes only, a special Column H entry is calculated to identify the estimated title IV-E agency share that would be required to be expended to claim the full amount shown in Column E along with a Column F Federal share amount. These amounts are labeled as “estimated” since the unused allocation may actually be expended in a subsequent FFY where the matching rate may differ from that applied to reported current quarter claims on this report.

(No entries are required. All columns are calculated for Capped Allocation projects as noted above.)

Line 24c. 75 Percent FFP Rate - Cumulative Title IV-E Capped Allocation Remaining Available for Expenditure - This line represents the amount of the Capped Allocation during the life of the demonstration project now remaining available for expenditure with Federal reimbursement at the 75 percent FFP rate. It consists of the total over the life of the project’s operations by which the 75 percent FFP rate Capped Allocation exceeds currently reported and previously funded 75 percent FFP rate expenditures. The calculation includes Line 17c minus Line 18c. This amount is reported as total computable only in Column E. An entry of zero (0) is made unless the result of the calculation is a positive number. For informational purposes only, a special Column H entry is calculated to identify the estimated title IV-E agency share that would be required to be expended to claim the full amount shown in Column E along with a Column F Federal share amount. These amounts are labeled as “estimated” since the unused allocation may actually be expended in a subsequent FFY where the matching rate may differ from that applied to reported current quarter claims on this report.

(No entries are required. All columns are calculated for Capped Allocation projects as noted above.)

III. All Program Projects

Line 9. Total Demonstration Project Operational Costs - This line includes the total title IV-E allowable costs (including any additional costs incurred to perform approved project interventions and those based on waivers granted) that are specifically associated with the operation of the demonstration project. The amount reported is equal to the sum of Lines 1a-2b and 5a-6c. This amount shall not be used in calculating the amount reported on Part 1, Line 16 for Foster Care, Line 25 for Adoption Assistance or Line 34a for Guardianship Assistance. The amounts on Line 25c of this Part should instead be used in calculating the reported amount in Part 1 (see instructions below). This step is necessary to consider other demonstration project costs and to limit the total computable or Federal share amount in accordance with the applicable cost-neutrality provisions.

(No entries are required. All columns are totaled as noted above.)

Line 10. Total Demonstration Project Developmental/Evaluation Costs - Total project administration costs cover specified activities that are required as a condition of implementing the demonstration project but do not represent payments or services on behalf of project participants. The amount reported is equal to the sum of Lines 3, 4, 7 and 8.

(No entries are required. All columns are totaled as noted above.)

Line 25a. Experimental Design Projects Subtotal - This line equals the sum of Lines 3 4, 14a and 14b.

(No entries are required. All columns are calculated for Experimental Design projects as noted above.)

Line 25b. Capped Allocation Design Projects Subtotal - [This line is automatically calculated

for Capped Allocation Design projects. No entries are required.] - This line equals the sum of Lines 7, 8, 20a, 20b and 20c.

(No entries are required. All columns are calculated for Capped Allocation projects as noted above.)

Line 25c. All Program Projects Total - [This line is automatically calculated. No entries are required.] This line equals the sum of Lines 25a plus line 25b. The entries on line 25c must be transferred (in the appropriate columns) to form CB-496, Part 1,Line 16 for Foster Care, Line 25 for Adoption Assistance or Line 34a for Guardianship Assistance projects.

(No entries are required. All columns are calculated as noted above.)

Line 25d. Title IV-E Agency Share of All Program Projects Total Estimates - Amount of non-Federal funds applicable to Line 25c that the title IV-E agency is certifying as available as matching funds for the demonstration project in the upcoming quarter. Calculated in Column H as: Line 25c (Column G) minus line 25c (Column H). 

(No entry required. Column Ha is calculated as noted above.)

IV. Foster Care Post-Demonstration Costs

Section E

Line 26a through Line 26f. – These lines include title IV-E foster care allowable (without waiver authority) cost claims for applicable periods in FFY 2020 in only those funding categories and geographical locations that would have been considered as subject to the cost neutrality limit (CNL) as specified for the title IV-E agency’s approved title IV-E demonstration project that was operational at the close of FFY 2019. Some of these demonstration projects provided for additional funding subcategory or general CNL applicability exclusions for specific groups of children or types of costs. This information is memorialized in section 4 of each demonstration project’s approved terms and conditions (T&C’s). Where the approved demonstration project’s T&C’s were amended, the version in effect on August 30, 2019 must be used to identify the costs subject to the project’s CNL. Additionally, certain title IV-E foster care funding categories are deemed to be outside of a demonstration project CNL because they were newly created after such projects were approved. These costs (see Part 3 General Instructions above and individual reporting line instructions) are to be reported on Part 1 of this report and not on a Part 3.report.

Note: Next quarter estimates reported costs are for the period that will end six months after the end of the current (claiming) quarter and will thus be for a period beyond FFY 2020 for two of the quarterly reports.

Any amount reported on these lines must not be reported in Part 1, Lines 1a -16a for Foster Care. The reported costs are used both for title IV-E Foster Care program funding and in the FFY 2020 Funding Certainty Grant calculation process.

Line 26a. FFY 2020 - Title IV-E Maintenance Assistance Payments – Foster Family Home (FMAP Rate). –Enter FFY 2020 payments and associated period next quarter estimates, as defined in Section 475(4)(A) of the Act, made by the title IV-E agency on behalf of children in a group subject to the former demonstration project’s CNL who are placed in a Foster Family Home as defined in Section 472(c)(1) of the Act. For periods prior to the title IV-E agency’s implementation of limitations on title IV-E foster care maintenance payments for placements that are not foster family homes (Section 472(k) of the Act), a title IV-E agency may also use this line to report payments made by the agency on behalf of eligible children placed in child care institutions that would otherwise be reportable on lines 26b or 26c. After the title IV-E agency’s delayed effective date for implementing the limitations on title IV-E maintenance payments for placements that are not foster family homes), the agency must report payments for children placed in child care institutions on line 26b or 26c, as described below. Title IV-E foster care maintenance payments reportable on Part 1, Line 1d for substance abuse treatment facilities must be reported on that line (regardless of former demonstration project connection) for all periods beginning on or after October 1, 2018. Title IV-E maintenance assistance payments made through a Tribal-State title IV-E agreement may also not be subject to a former demonstration project CNL (unless specified as such in the approved terms and conditions) and must, in that instance, be reported in Part 1 on Lines 2a or 2b rather than on this line.

The Federal share of any child support collections made on behalf of the children whose maintenance payments are reported on this line must be reported in Part 1, line 3.

(Enter amounts directly in Columns A, C, D and G. Columns B, E, F and H are automatically calculated to display Federal share or totals.)

Line 26b. FFY 2020 - Title IV-E Maintenance Assistance Payments – Specified Setting Child Care Institution (FMAP Rate). – Enter the FFY 2020 payments and associated period next quarter estimates, as defined in Section 475(4)(A) of the Act, made by the title IV-E agency on behalf of children in a group subject to the former demonstration project’s CNL who are placed in a Specified Setting Child Care Institution as defined in Sections 472(c)(2) and 472(k)(2) of the Act. Additional requirements for title IV-E reimbursement apply to those Specified Setting Child Care Institutions consisting of a Qualified Residential Treatment Program placement as per Sections 472(k)(3) and (4). Payments reported on this line cannot begin earlier than the effective date (including any election of a delayed effective date) of the title IV-E agency’s title IV-E Plan amendment to implement Section 472(k) of the Act.

(Enter amounts directly in Columns A, C, D and G. Columns B, E, F and H are automatically calculated to display Federal share or totals.)

Line 26c. FFY 2020 - Title IV-E Maintenance Assistance Payments – Non-Specified Setting Child Care Institution (FMAP Rate). Enter the FFY 2020 payments and associated period next quarter estimates, as defined in Section 475(4)(A) of the Act, made by the title IV-E agency on behalf of children in a group subject to the former demonstration project’s CNL who are placed in a Child Care Institution as defined in Section 472(c)(2) of the Act that does not meet the specified setting requirements at Section 472(k)(2) of the Act. Such payments are generally limited to covering a two-week period for each placement. Payments for any continuous child care institution placements with a start date prior to the effective date for Section 472(k)(2) of the Act are not time limited but must also be reported on this line. For periods prior to the effective date of Section 472(k)(2) of the Act, or for title IV-E agencies that have elected a delayed effective date for this provision, maintenance assistance payments made for placements in a child care institution during the non-effective or delay period (without application of the two-week period limit) are treated as “non-specified setting” placements and are thus to be reported on this line. During this period, an option is also available to consolidate the reporting of foster care maintenance payments for foster family homes and child care institutions. See the Part 1, Line 1a instruction for details.

(Enter amounts directly in Columns A, C, D and G. Columns B, E, F and H are automatically calculated to display Federal share or totals.)

Line 26d. FFY 2020 - Title IV-E In-Placement Administration – Case Planning and Management (50 Percent FFP Rate). – Costs reported on this line are title IV-E allowable (without waiver authority) amounts for applicable periods in FFY 2020 (and associated period next quarter estimates) spent on behalf of children in a group subject to the former demonstration project’s CNL and where in-placement administration for case planning and management activities (all or specified subcategories) is considered as part of the former demonstration project’s CNL. These costs may only cover the items classified as title IV-E in-placement administration in accordance with Federal regulations at 45 CFR 1356.60(c) and form CB-496, Part 1 instructions for Lines 5–7 (Foster Care). Costs for in-placement administration - legal representation- parent or child are excluded and must be reported in Part 1 on Line 8. This line should remain blank if costs in the in-placement administration funding category are not subject to a CNL under the former demonstration project.

(Enter amounts directly in Columns A, C, D and G. Columns B, E, F and H are automatically calculated to display Federal share or totals.)

Line 26e. FFY 2020 - Title IV-E Candidate Administrative Costs - Case Planning and Management (50 Percent FFP Rate). - Costs reported on this line are title IV-E allowable (without waiver authority) amounts for applicable periods in FFY 2020 (and associated period next quarter estimates) spent on behalf of children in a group subject to the former demonstration project’s CNL who are determined as title IV-E foster care candidates where candidate administration is considered as part of the former demonstration project’s CNL. These costs may only cover the items classified as title IV-E candidate pre-placement administration in accordance with Federal regulations at 45 CFR 1356.60(c) and form CB-496, Part 1 instructions for Line 10a. This line should remain blank if costs in the candidate administration funding category are not subject to a CNL under the former demonstration project.

(Enter amounts directly in Columns A, C, D and G. Columns B, E, F and H are automatically calculated to display Federal share or totals.)

Line 26f. FFY 2020 - Title IV-E Staff/Provider and Professional Partner Training Costs (75% FFP Rate) - Costs reported on this line are title IV-E allowable (without waiver authority) amounts for applicable periods in FFY 2020 (and associated period next quarter estimates) spent on behalf of children in a group subject to the former demonstration project’s CNL and where training is considered as part of the capped allocation design CNL. These costs may only cover the items classified as title IV-E training in accordance with Federal regulations at 45 CFR 1356.60(b) and form CB-496, Part 1 instructions for Line 15 (Foster Care). This line should remain blank if costs in the training funding category are not subject to a CNL under the former demonstration project.

(Enter amounts directly in Columns A, C and G for Capped Allocation Design projects where training costs are considered in the CNL. Columns B, D, E, F and H are automatically calculated to display Federal share or totals.)

Line 26g. FFY 2020 - Subtotal Post-Demonstration Title IV-E Foster Care Costs. [This line is automatically calculated. No entries are required.] - This line equals the sum of Lines 26a – 26f.

(No entries are required. All columns are calculated as noted above.)

Line 27a through Line 27f. – These lines include title IV-E foster care allowable (without waiver authority) cost claims for applicable periods in FFY 2021 in only those funding categories and geographical locations that would have been considered as subject to the cost neutrality limit (CNL) as specified for the title IV-E agency’s approved title IV-E demonstration project that was operational at the close of FFY 2019. Some of these demonstration projects provided for additional funding subcategory or general CNL applicability exclusions for specific groups of children or types of costs. This information is memorialized in section 4 of each demonstration project’s approved terms and conditions (T&C’s). Where the approved demonstration project’s T&C’s were amended, the version in effect on August 30, 2019 must be used to identify the costs subject to the project’s CNL. Additionally, certain title IV-E foster care funding categories are deemed to be outside of a demonstration project CNL because they were newly created after such projects were approved. These costs (see Part 3 General Instructions above and individual reporting line instructions) are to be reported on Part 1 of this report and not on a Part 3 report.

Note: Next quarter estimates reported costs are for the period that will end six months after the end of the current (claiming) quarter and will thus be for a period beyond FFY 2021 for two of the quarterly reports.

Any amount reported on these lines must not be reported in Part 1, Lines 1a -16a for Foster Care. The reported costs are used both for title IV-E Foster Care program funding and in the FFY 2021 Funding Certainty Grant calculation process.

Line 27a. FFY 2021 - Title IV-E Maintenance Assistance Payments – Foster Family Home (FMAP Rate). –Enter the FFY 2021 payments and associated period next quarter estimates, as defined in Section 475(4)(A) of the Act, made by the title IV-E agency on behalf of children in a group subject to the former demonstration project’s CNL who are placed in a Foster Family Home as defined in Section 472(c)(1) of the Act. For periods prior to the title IV-E agency’s implementation of limitations on title IV-E foster care maintenance payments for placements that are not foster family homes (Section 472(k) of the Act), a title IV-E agency may also use this line to report payments made by the agency on behalf of eligible children placed in child care institutions that would otherwise be reportable on lines 27b or 27c. After the title IV-E agency’s delayed effective date for implementing the limitations on title IV-E maintenance payments for placements that are not foster family homes), the agency must report payments for children placed in child care institutions on line 27b or 27c, as described below. Title IV-E foster care maintenance payments reportable on Part 1, Line 1d for substance abuse treatment facilities must be reported on that line (regardless of former demonstration project connection) for all periods beginning on or after October 1, 2018. Title IV-E maintenance assistance payments made through a Tribal-State title IV-E agreement may also not be subject to a former demonstration project CNL (unless specified as such in the approved terms and conditions) and must, in that instance, be reported in Part 1 on Lines 2a or 2b rather than on this line.

The Federal share of any child support collections made on behalf of the children whose maintenance payments are reported on this line must be reported in Part 1, line 3.

(Enter amounts directly in Columns A, C, D and G. Columns B, E, F and H are automatically calculated to display Federal share or totals.)

Line 27b. FFY 2021 - Title IV-E Maintenance Assistance Payments – Specified Setting Child Care Institution (FMAP Rate). – Enter the FFY 2021 payments and associated period next quarter estimates, as defined in Section 475(4)(A) of the Act, made by the title IV-E agency on behalf of children in a group subject to the former demonstration project’s CNL who are placed in a Specified Setting Child Care Institution as defined in Sections 472(c)(2) and 472(k)(2) of the Act. Additional requirements for title IV-E reimbursement apply to those Specified Setting Child Care Institutions consisting of a Qualified Residential Treatment Program placement as per Sections 472(k)(3) and (4). Payments reported on this line cannot begin earlier than the effective date (including any election of a delayed effective date) of the title IV-E agency’s title IV-E Plan amendment to implement Section 472(k) of the Act.

(Enter amounts directly in Columns A, C, D and G. Columns B, E, F and H are automatically calculated to display Federal share or totals.)

Line 27c. FFY 2021 - Title IV-E Maintenance Assistance Payments – Non-Specified Setting Child Care Institution (FMAP Rate). Enter the FFY 2021 payments and associated period next quarter estimates, as defined in Section 475(4)(A) of the Act, made by the title IV-E agency on behalf of children in a group subject to the former demonstration project’s CNL who are placed in a Child Care Institution as defined in Section 472(c)(2) of the Act that does not meet the specified setting requirements at Section 472(k)(2) of the Act. Such payments are generally limited to covering a two-week period for each placement. Payments for any continuous child care institution placements with a start date prior to the effective date for Section 472(k)(2) of the Act are not time limited but must also be reported on this line. For periods prior to the effective date of Section 472(k)(2) of the Act, or for title IV-E agencies that have elected a delayed effective date for this provision, maintenance assistance payments made for placements in a child care institution during the non-effective or delay period (without application of the two-week period limit) are treated as for “non-specified setting” placements and are thus to be reported on this line. During this period, an option is also available to consolidate the reporting of foster care maintenance payments for foster family homes and child care institutions. See the Part 1, Line 1a instruction for details.

(Enter amounts directly in Columns A, C, D and G. Columns B, E, F and H are automatically calculated to display Federal share or totals.)

Line 27d. FFY 2021 - Title IV-E In-Placement Administration – Case Planning and Management (50 Percent FFP Rate). – Costs reported on this line are title IV-E allowable (without waiver authority) amounts for applicable periods in FFY 2021 (and associated period next quarter estimates) spent on behalf of children in a group subject to the former demonstration project’s CNL and where in-placement administration for case planning and management activities is considered (all or specified subcategories) as part of the former demonstration project’s CNL. These costs may only cover the items classified as title IV-E in-placement administration in accordance with Federal regulations at 45 CFR 1356.60(c) and form CB-496, Part 1 instructions for Lines 5–7 (Foster Care). Additional project costs for these or other children are reported elsewhere in this Part. Costs for in-placement administration - legal representation- parent or child are excluded and must be reported in Part 1 on Line 8. This line should remain blank if costs in the in-placement administration funding category are not subject to a CNL under the former demonstration project.

(Enter amounts directly in Columns A, C, D and G. Columns B, E, F and H are automatically calculated to display Federal share or totals.)

Line 27e. FFY 2021 - Title IV-E Candidate Administrative Costs - Case Planning and Management (50 Percent FFP Rate). - Costs reported on this line are title IV-E allowable (without waiver authority) amounts for applicable periods in FFY 2021 (and associated period next quarter estimates) spent on behalf of children in a group subject to the former demonstration project’s CNL who are determined as title IV-E foster care candidates where candidate administration is considered as part of the former demonstration project’s CNL. These costs may only cover the items classified as title IV-E candidate pre-placement administration in accordance with Federal regulations at 45 CFR 1356.60(c) and form CB-496, Part 1 instructions for Line 10a. This line should remain blank if costs in the candidate administration funding category are not subject to a CNL under the former demonstration project.

(Enter amounts directly in Columns A, C, D and G. Columns B, E, F and H are automatically calculated to display Federal share or totals.)

Line 27f. FFY 2021 - Title IV-E Staff/Provider and Professional Partner Training Costs (75% FFP Rate) - Costs reported on this line are title IV-E allowable (without waiver authority) amounts for applicable periods in FFY 2021 (and associated period next quarter estimates) spent on behalf of children in a group subject to the former demonstration project’s CNL and where training is considered as part of the capped allocation design CNL. These costs may only cover the items classified as title IV-E training in accordance with Federal regulations at 45 CFR 1356.60(b) and form CB-496, Part 1 instructions for Line 15 (Foster Care). This line should remain blank if costs in the training funding category are not subject to a CNL under the former demonstration project.

(Enter amounts directly in Columns A, C and G for Capped Allocation Design projects where training costs are considered in the CNL. Columns B, D, E, F and H are automatically calculated to display Federal share or totals.)

Line 27g. FFY 2021 - Subtotal Post-Demonstration Title IV-E Foster Care Costs. [This line is automatically calculated. No entries are required.] - This line equals the sum of Lines 27a – 27f.

(No entries are required. All columns are calculated as noted above.)

Line 28a. Total Post-Demonstration Title IV-E Foster Care Costs. [This line is automatically calculated. No entries are required.] - This line equals the sum of Lines 26g – 27g.

(No entries are required. All columns are calculated as noted above.)

Line 28b. Title IV-E Agency Share of Post-Demonstration Title IV-E Foster Care Costs Total Estimates - Amount of non-Federal funds applicable to Line 28a that the title IV-E agency is certifying as available as matching funds for the post-demonstration costs in the upcoming quarter. Calculated in Column H as: Line 28a (Column G) minus line 28a (Column H). 

(No entry required. Column H is calculated as noted above.)

V. Funding Certainty Grant Calculations

Section F

Line 29. Baseline - FFY 2019 Capped Allocations (All Funding Categories) [This line is automatically populated. No entries are required.] - The baseline for calculating Funding Certainty Grants is the sum of capped allocations provided for FFY 2019 as specified in section 4.3 of the approved waiver terms and conditions document capped allocation payment table in effect on August 31, 2019. Although the cited table identifies amounts in total computable dollars, the federal share is calculated and populated by the Children’s Bureau for use in comparison to reported post-demonstration costs for each FFY (FFYs 2020 and 2021).

Line 30a. FFY 2020 - Annual Funding Certainty Level (90% of Baseline) [This line is automatically calculated. No entries are required.] - This line equals Line 29 multiplied by the applicable percentage for FFY 2020 (90%) as specified in section 602(c)(2)(B)(i).

Line 30b. FFY 2020 - Reported Title IV-E Foster Care Post-Demonstration Costs [This line is automatically calculated. No entries are required.] - This line equals Line 26g from this report (Column B) and the cumulative amount reported to date on all Part 3, section E reports on Line 26g (Column C).

Line 30c. FFY 2020 - Foster Care Post-Demonstration Calculated Funding Certainty Grant Calculated Level/Awards (If Any) [This line is automatically calculated. No entries are required.] This line in Column C equals a positive amount calculated by subtracting Line 30a (Column C) from Line 30b (Column C). It thus indicates the calculated earned level to date of any FFY 2020 Funding Certainty Grant. This line also displays any previously issued Funding Certainty Grant for FFY 2020 (Column D) and any calculated potential next Funding Certainty Grant (Column E). Additional information about the Funding Certainty Grants will be provided through a separate Program Instruction.

Line 31a. FFY 2021 - Annual Funding Certainty Level (75% of Baseline) [This line is automatically calculated. No entries are required.] - This line equals Line 29 multiplied by the applicable percentage for FFY 2021 (75%) as specified in section 602(c)(2)(B)(ii).

Line 31b. FFY 2021 - Reported Title IV-E Foster Care Post-Demonstration Costs

[This line is automatically calculated. No entries are required.] - This line equals Line 27g from this report (Column B) and the cumulative amount reported to date on all Part 3, section E reports on Line 27g (Column C).

Line 31c. FFY 2021 - Foster Care Program Post-Demonstration Calculated Funding Certainty Grant Calculated Level/Awards (If Any) [This line is automatically calculated. No entries are required.] - This line in Column C equals a positive amount calculated by subtracting Line 31a (Column C) from Line 31b (Column C). It thus indicates the calculated earned level to date of any FFY 2021 Funding Certainty Grant. This line also displays any previously issued Funding Certainty Grant for FFY 2020 (Column D) and any calculated potential next Funding Certainty Grant (Column E). Additional information about the Funding Certainty Grants will be provided through a separate Program Instruction.

Part 4: Annual Adoption Savings Calculation and Accounting Report

(This Part is to be submitted for one period each year (with the 4th quarter current quarter report) and is applicable to all states or tribes with an approved title IV-E plan.)

ANNUAL ADOPTION SAVINGS CALCULATION AND ACCOUNTING REPORT

General Instructions:

Each title IV-E agency must report any annual calculated adoption savings and the expenditure of identified adoption savings on Part 4 of Form CB-496. This requirement is in accordance with section 473 (a)(8)(B) of the Act. Adoption Savings consist of specified title IV-E Adoption Assistance claimed costs on behalf of an Applicable Child Only Status case (see definitions below). All Part 4 entries are to be made in accordance with these instructions and any approved title IV-E agency Annual Adoption Savings Calculation Methodology.

Completion of Part 4 will require the development and maintenance of schedules to accumulate needed caseload and cost data by the title IV-E agency. The data used to calculate adoption savings may either reflect actual amounts as derived from the title IV-E agency’s management system or calculated amounts in accordance with either the Children’s Bureau (CB) Annual Adoption Savings Calculation Methodology or an Alternate Approved Method (see definitions below).

Title IV-E agencies must submit Part 4 of this report annually with the Form CB-496 report for the current quarter ended September 30th of each year. Each Part 4 submission covers an entire federal fiscal year (FFY). Part 4 reporting is required beginning with FFY 2015. The Part 4 must be submitted even if the annual calculation results do not identify any adoption savings.

Column A of Part 4, entitled “Current FFY”, includes amounts for the four quarters in the current FFY reporting period. The section A, Column A entries are primarily derived from amounts reported on Form CB-496 Part 1 Adoption Assistance lines as current quarter amounts in one of the four quarters of the current FFY. Any prior quarter adjustment claims submitted on Form CB-496 reports for quarters during the current FFY where the adjustment is identified (Part 2, Column D) as being applicable for a quarter within the current reporting FFY are, however, also considered in Column A of Part 4. There is no provision to submit adjustments to amounts reported in Part 4 in either Column A or Column B. If it is determined that information submitted on a CB-496 Part 4 is incorrect, a revised report for that reporting period must be submitted.

Column B of Part 4, entitled “Prior Reported FFYs – As Specified by Instructions”, captures differing information depending on the section and the reporting line. The amounts reported in Column B are limited to prior FFYs for which Part 4 reporting was required. Since FFY 2015 is the first FFY subject to Part 4 reporting, the Part 4 submission for the FFY 2015 reporting period will not contain any entries in Column B. Likewise, a Part 4 submission for any subsequent FFY will include amounts in Column B that do not go back any further than FFY 2015. Additionally, it must be understood that unlike the “prior quarter adjustment” columns utilized in Parts 1 and 3 of Form CB-496, Part 4 Column B does not adjust previously reported amounts on each line. Instead, it addresses the calculation or expenditure of adoption savings with respect to periods before the current FFY.

In section A of Part 4, Column B generally (except as noted below) identifies the adoption savings related impact of those prior quarter adjustments (increasing or decreasing) submitted on a Form CB-496 Part 1 report for periods within the current FFY but identified (Part 2, Column D) as applicable to periods in prior FFYs. The Part 4, line 1 Column B data differs in that it reports the cumulative total calculated adoption savings from all previous FFYs for purposes of maintaining a running total of such amounts. Line 2, Column B also follows differing instructions in that it captures the number reported on the Part 4 submission (if any) for the immediately prior FFY.

Amounts entered in section A, Column B are thus not “adjustments” in the sense that they are changing an amount previously reported on a Part 4 submission. The amounts reported are, instead, either a cumulative carry forward from the prior FFY report (Line 1) or newly calculated amounts for applicable periods in prior reported FFYs (Lines 3 and 5) derived from prior quarter adjustment claims that were submitted on CB-496 Part 1 reports for quarters in the current FFY.

In section B of Part 4, Column B generally (except as noted below) identifies expenditures from adoption savings that were made in a quarter that is prior to the identified current FFY reporting period. These expenditures are usually newly reported amounts that were paid in a prior FFY. It is also possible that some amounts are “adjustments” in the sense that they are changing an amount previously reported on a Part 4 submission. The line 9 Column B data differs from the other section B lines in that it reports the cumulative total expenditure of calculated adoption savings from all previous FFYs for purposes of maintaining a running total of such amounts.

Part 4 Column C does not require any entries. It sums the amounts in Column A and Column B to identify a Total on each line. Note: Since FFY 2015 was the first reporting period for Part 4, the submission for this FFY did not have any amounts reported in Column B.

Definitions:

Adoption Savings Reporting Periods – Each reporting period for adoption savings purposes consists of a federal fiscal year (FFY). The reporting period identified as the “current FFY” on each Part 4 submission is the FFY ending with the “current quarter” identified (4th quarter of the FFY) on Part 1 of the same quarterly Form CB-496 submission. The “prior FFY” reference in Part 4 refers to the FFY immediately before the current FFY. The ”prior reported FFYs” reference in Part 4 refers to any FFY before that is subject to reporting of adoption savings in Part 4. This does not include a FFY before FFY 2015.

Applicable Child - For title IV-E Adoption Assistance purposes, those children meeting the age related and other criteria specified at section 473(e) of the Social Security Act as amended by section 50781(a) of P.L. 115-123.

Applicable Child Eligibility Criteria – For title IV-E Adoption Assistance purposes, the determination of program eligibility in accordance with special criteria at sections 473(a)(2)(A)(ii) and 473(a)(7) of the Act.

Applicable Child Only Status – Those children who are subject to applicable child eligibility criteria that are determined as eligible for title IV-E adoption assistance, but would not be title IV-E eligible without applying such criteria. There will be some children who meet the criteria as an applicable child, but would have been eligible for title IV-E adoption assistance without considering that criteria. Such children are excluded from this definition.

Annual Adoption Savings – The dollar amount of federal financial participation (FFP) over a federal fiscal year (FFY) of title IV-E claimed costs for adoption assistance which would have been borne entirely by the title IV-E agency (non-title IV-E reimbursable) which are now subject to title IV-E FFP only because of the determination of title IV-E eligibility based on applicable child only status.

Annual Adoption Savings Calculation Methodology – A set of procedures used to calculate annual adoption savings on behalf of title IV-E applicable child only cases (where actual amounts are not available) in accordance with section 473 ((a)(8)(A) of the Act. If a title IV-E cannot identify these actual amounts it must either use the Children’s Bureau calculation methodology (described below) or propose an alternate method that is subject to approval by the Children’s Bureau.

Children’s Bureau (CB) Annual Adoption Savings Calculation Methodology – A specific set of procedures used to calculate annual adoption savings on behalf of title IV-E applicable child only cases (either actual or calculated amounts depending on data availability) in accordance with section 473 ((a)(8)(A) of the Act. These procedures are available through ACYF-CB-PI-15-06, dated May 22, 2015 and involve identification of applicable child only status cases through random case sampling and the determination of title IV-E adoption assistance claims (in several funding categories) on behalf of such cases through calculation of average claims per title IV-E assisted child.

CB Method With Actual Amounts Annual Adoption Savings Calculation Methodology – The procedures for annual adoption savings calculations using actual amounts follow the “Children’s Bureau (CB) Annual Adoption Savings Calculation Methodology” (see definition above) whereby actual amounts, as available, are substituted for case sampling results or statistical data in performing the annual adoption savings calculation. The substituted amounts include actual children within the title IV-E agency’s jurisdiction that were determined as meeting applicable child only status and on whose behalf specifically identified adoption assistance payments (if available) were title IV-E claimed during a FFY. The procedures for adoption savings calculations using actual amounts are available through ACYF-CB-PI-15-06, dated May 22, 2015.

Alternate Approved Annual Adoption Savings Calculation Methodology – A set of procedures proposed by a title IV-E agency and approved by the Children’s Bureau used to calculate annual adoption savings on behalf of title IV-E applicable child only cases (where actual amounts are not available) in accordance with section 473 ((a)(8)(A) of the Act. This methodology is then used as an alternate to the “Children’s Bureau Annual Adoption Savings Calculation Methodology” including use of that methodology with actual amounts. Any proposed alternate method must result in the calculation of annual adoption savings amounts in the funding categories reported in this Part that are reasonably close to amounts that would expect to be calculated using the Children’s Bureau Annual Adoption Savings Calculation Methodology. The procedures for developing proposals for adoption savings calculations using an alternate method are available through ACYF-CB-PI-15-06, dated May 22, 2015.

Annual Adoption Savings Calculation Methodology Determination Notification – Each title IV-E agency must annually notify the ACF Children’s Bureau of its decision to utilize the Children’s Bureau Annual Adoption Savings Calculation Methodology (either as published or with the substitution of actual amounts) for calculating adoption savings for each FFY or of its intention to pursue an Alternate Approved Method. The procedures and submission timing for such notices was issued through ACYF-CB-PI-15-06, dated May 22, 2015.

Beginning with notifications for FFY 2018 and later FFYs, an Annual Adoption Savings Calculation Methodology Notification need only to be submitted if:

1. The title IV-E agency has not previously submitted such a form for FFY 2017; or

2. The method chosen by the title IV-E agency for the current FFY has changed from the one used in the immediately prior FFY, or

3. The procedures used by the title IV-E agency for the assembly of data or conducting the calculation through a method other than the CB Method differ from those used in the immediately prior FFY.

Further information on each annual submission will be provided by the CB through an electronic listserv notice to all title IV-E agencies. This notice is expected to be sent in the early part of June of each year.

Part 4 Report Heading Information:

• Enter the name of the State or Tribe.

• Enter the Reporting Period which consists of the FFY for which current quarter expenditures are reported in Part 1 of this report

• Check the appropriate box (i.e. “Children’s Bureau (CB) Method”, “CB Method With Actual Amounts”, or “Alternate Approved Method”) to indicate which annual adoption savings calculation methodology is used for this Part 4 submission. The selected methodology must be in accordance with the title IV-E agency’s latest required “Annual Adoption Savings Calculation Methodology Determination Notification” and, if an “Alternate Approved Method” is chosen, the required Children’s Bureau’s approval of that method must have been granted prior to submission of this report.

Note: If actual child specific data is used to complete lines 2 and 3, check “CB Method With Actual Amounts” even though the “Children’s Bureau (CB) Method” is otherwise used to calculate average claiming data used in reporting on line 5.

• Check the box to indicate if this is a new report or a revision to a report previously submitted.

Part 4 Sections Overview:

Section A – Adoption Savings Calculation

This section is for reporting the calculated adoption savings amounts. The adoption savings calculated are derived from title IV-E Adoption Assistance program claims submitted on Form CB-496 Part 1 in the reporting period within the funding categories of assistance payments and administrative costs - agency. The calculations are made in accordance with the Children’s Bureau (CB) Method, CB Method With Actual Amounts or an Alternate Approved Method. With the possible exception of an alternate approved method all calculations involve use of the average monthly number of children in the reporting period determined as applicable child only status cases. All dollar amounts reported in Section A, as per line item instructions, either consist of title IV-E total computable claims or the federal share of such amounts.

Section B – Adoption Savings Expenditures

This section is for reporting the actual expenditure of calculated adoption savings amounts. The expenditure amounts to be reported are limited to adoption savings calculated and reported on Part 4 in section A. Therefore, the cumulative total expenditures reported on line 14 must not exceed the cumulative total calculated adoption savings reported on line 8 of this Part. In section B, columns A and B refer to the period in which a reported expenditure was made. Column A is used to report expenditures made in the “Current FFY’ and Column B identifies expenditures made in a “Prior Reported FFY”. A reported FFY is one that is subject to adoption savings reporting (no earlier than FFY 2015). Amounts reported in Column B may consist of additional amounts not previously reported or adjustments to previously reported amounts. Title IV-E agencies must, however, maintain workpapers to establish which reported expenditures are attributable to adoption savings reported as calculated for each FFY.

Amounts reported in section B must be actual expenditures (see the definition of Expenditures in Part 1 of these instructions) of non-federal funds that are not also claimed for federal reimbursement or, in most instances, as matching funds to secure federal financial participation. For expenditure periods beginning in FFY 2020 and later, expenditures of calculated adoption savings may be used as a component of the non-federal match for optional title IV-E programs (i.e., Guardianship Assistance, Prevention Services or Kinship Navigator) to the extent that the non-supplantation parameters described in the Child Welfare Policy Manual are met. Reported expenditures are limited to services and items that are allowable for purposes of title IV-B and title IV-E programs in accordance with section 473(a)(8)(D)(i) of the Act. These expenditures must also, in accordance with section 473(a)(8)(D)(ii) of the Act, supplement, not supplant, any federal or non-federal funds used to provide any service under titles IV-B or IV-E. Title IV-E agencies are also reminded that if any costs reported as adoption savings expenditures are part of a pool of costs that are subject to inclusion in a public assistance cost allocation plan (PACAP) or a cost allocation methodology (CAM) they must be appropriately addressed in those documents as per 45 CFR 1356.60(c) and other applicable cost allocation requirements.

Although specific expenditures do not need to be associated with adoption savings calculated for a particular current FFY, amounts reported as expenditures of adoption savings must be expended no earlier than the current FFY in which equivalent levels of adoption savings were calculated and reported in Part 4. For example, if a title IV-E agency first calculates adoption savings in the FFY 2016 Form CB-496 Part 4 “Current FFY” reporting period; it cannot classify FFY 2015 expenditures as a use of the FFY 2016 calculated adoption savings.

Section C – Unexpended Adoption Savings

This section identifies the calculated amounts of cumulative adoption savings (lines 1 and 8) which have not yet been reported in section B of Part 4 as expended by the title IV-E agency. These balances are identified as of the following points: 1) close of the immediately prior FFY reporting period; 2) with respect to identified adoption savings and expenditures for the current FFY, and: 3) as a cumulative total at the end of the current FFY. Calculated adoption savings amounts are not required to be expended in the same FFY as when they are identified. Ultimately, however, all identified adoption savings must be expended in accordance with section 473(a)(8)(D)(i) of the Social Security Act.

Part 4 Line by Line Instructions

Line 1. Prior Reported FFYs - Total Cumulative Calculated Adoption Savings (All Categories) – This line includes the cumulative total of adoption savings calculated and reported on Form CB-496 Part 4 in those reporting periods consisting of all prior FFYs. An entry is made only in Column B since this line does not contain any amounts sourced from the current FFY. The entry must be taken directly from the amount reported on the CB-496 Part 4 for the immediately prior FFY on line 8, Column C

(Enter amounts directly on this form in Column B only.)

Line 2. Average Monthly Number of Children: Current FFY & Prior FFY Title IV-E Adoption Assistance Payments "Applicable Child Only" Status – The entry on this line consists of a portion of the universe of the average monthly number of children reported on Form CB-496 Part 1, line 53 as current quarter children assisted for the four quarters during a FFY. The appropriate “applicable child” portion to be entered can be derived from Actual Amounts, through application of the Children’s Bureau Methodology or through an Alternate Approved Method. If an alternate approved method does not include the counting of applicable children, an entry of “N/A” should be made on line 2. The current FFY entry must be made in Column A based on data for the reporting period FFY. The Column B entry consists of the same information for the immediately prior FFY only if that FFY is subject to Part 4 reporting (FFYs 2015 and later). This data is as reported on Part 4, line 2, Column A for that FFY.

The reported line 2 numbers are a factor used (except for a possible exception for an alternate approved method) to calculate the portion of the current FFY title IV-E Adoption Assistance claims (current quarter and prior quarter adjustments for periods when adoption savings reporting is required) attributable to applicable children. Note: Column C is not used for this line.

(Enter amounts directly on this form in Column A and Column B only.)

Line 3. Adoption Assistance Payments (Total Computable) On Behalf of Line 2 Applicable Children – This line consists of the actual or calculated (using an approved method) total computable amount of title IV-E adoption assistance payments on behalf of the applicable child only status cases identified on Part 4, line 2 (unless not required to be reported as part of an alternate approved method) that were claimed on Form CB-496 Part 1 submissions for the four quarters of the reporting period (current FFY) as either current quarter expenditures or as prior quarter adjustments. The Column A entry is derived from amounts reported as either current quarter claims or as prior quarter adjustment claims where the applicable fiscal quarter ended is within the current FFY. The Column B entry is derived from any amounts reported as prior quarter adjustment claims where the applicable fiscal quarter ended is within a FFY that is prior to the current FFY, but among those subject to adoption savings reporting. The pool of title IV-E claims subject to consideration in reporting this amount is as follows: Current FFY Form CB-496 Part 1, lines 20 and 21 Column A entries plus any Column C entries identified in Part 2 as applicable to a fiscal quarter ended that is within a FFY subject to adoption savings reporting. Note: Column C is the total of the entries in columns A and B.

(Enter amounts directly on this form in Column A and Column B only. Column C is the calculated total of these entries.)

Line 4. Calculated Adoption Assistance Payment Savings On Behalf of Line 2 Applicable Children (FMAP Rate Federal Share of Line 3) – This line represents the amount of savings to the title IV-E agency associated with title IV-E adoption assistance payment claims. The federal funding identified would not otherwise have been received absent the availability of the applicable child eligibility criteria. It is generally calculated (not necessarily where an alternate approved method is used) by multiplying the Part 4, line 3 amount by the applicable FMAP rate (current FFY FMAP rate for Column A and prior FFY FMAP rate for Column B). The Column C total is the sum of columns A and B.

(No entries are required. All columns are calculated as noted above.)

Line 5. Adoption Assistance Administration (Total Computable) On Behalf of Line 2 Applicable Children – This line consists of the actual or calculated (using an approved method) total computable amount of title IV-E adoption assistance administrative cost – agency claims on behalf of the applicable child only status cases identified on Part 4, line 2 (unless not required to be reported as part of an alternate approved method) that were claimed on CB-496 Part 1 submissions for the four quarters of the reporting period (current FFY) as either current quarter expenditures or as prior quarter adjustments. The Column A entry is derived from amounts reported as either current quarter claims or as prior quarter adjustment claims where the applicable fiscal quarter ended is within the current FFY. The Column B entry is derived from any amounts reported as prior quarter adjustment claims where the applicable fiscal quarter ended is within a FFY that is prior to the current FFY, but among those subject to adoption savings reporting. The pool of title IV-E claims subject to consideration in reporting this amount is as follows: Current FFY Form CB-496 Part 1, line 22 Column A entries plus any Column C entries identified in Part 2 as applicable to a fiscal quarter ended that is within a FFY subject to adoption savings reporting. Note: Column C is the total of the entries in columns A and B.

(Enter amounts directly on this form in Column A and Column B only. Column C is the calculated total of these entries.)

Line 6. Calculated Adoption Assistance Administration Savings On Behalf of Line 2 Applicable Children (50% Federal Share Rate of Line 5) – This line represents the amount of savings to the title IV-E agency associated with title IV-E adoption assistance administrative costs – agency claims. The federal funding identified would not otherwise have been received absent the availability of the applicable child eligibility criteria. It is generally calculated (not necessarily where an alternate approved method is used) by multiplying the Part 4, line 5 amount in columns A and B by the federal financial participation (FFP) rate applicable for administration (50% FFP). The Column C total is the sum of columns A and B.

(No entries are required. All columns are calculated as noted above.)

Line 7. Reporting Period - Total Calculated Adoption Savings (All Categories) On Behalf of Line 2 Applicable Children – This line represents the total calculated amount of adoption savings to the title IV-E agency represented through the federal share of title IV-E claims on behalf of applicable child only status cases. The federal funding identified would not otherwise have been received absent the availability of the applicable child eligibility criteria. The amounts reported in each column are calculated from the sum of the corresponding amounts on lines 4 and 6 in this Part.

(No entries are required. All columns are calculated as noted above.)

Line 8. Cumulative - Total Calculated Adoption Savings (All Categories) Available For Expenditure (lines 1 + 7) – This line represents the cumulative total calculated amount of adoption savings for all FFYs subject to adoption savings reporting. The amounts reported in each column are calculated from the sum of the amount on lines 1 and 7 in this Part.

(No entries are required. All columns are calculated as noted above.)

Line 9. Prior Reported FFYs - Total Cumulative Expenditure of Calculated Adoption Savings (Line 1 Amount) – This line includes the cumulative total of calculated adoption savings that were expended and reported on Form CB-496 Part 4 in those Part 4 reporting periods consisting of all prior FFYs. An entry is made only in Column B since this line does not contain any amounts sourced from the current FFY. The entry must be taken directly from the amount reported on the CB-496 Part 4 for the immediately prior FFY on line 14, Column C.

(Enter amounts directly on this form in Column B only.)

Line 10. Reporting Period - Expenditures of Adoption Savings On Post-Adoption or Post-Guardianship Services (from line 8 amount) – This line consists of the actual title IV-E agency expenditures (without federal matching funds) of calculated cumulative adoption savings for the purposes of providing post-adoption or post-guardianship services. Amounts reported include expenditures made in the current FFY (in Column A) and any expenditures made in a prior FFY subject to Part 4 reporting (Column B) that have either not previously been reported on a Part 4 submission or are adjustments to amounts previously so reported.

(Enter amounts directly on this form in Column A and Column B only. Column C is the calculated total of these entries.)

Line 11. Reporting Period - Expenditures of Adoption Savings On Services for Children At Risk of Foster Care (from line 8 amount) – This line consists of the actual title IV-E agency expenditures (without federal matching funds) of calculated cumulative adoption savings for the purposes of providing services to support positive permanent outcomes for children at risk of entering foster care. Amounts reported include expenditures made in the current FFY (in Column A) and any expenditures made in a prior FFY subject to Part 4 reporting (Column B) that have either not previously been reported on a Part 4 submission or are adjustments to amounts previously so reported.

(Enter amounts directly on this form in Column A and Column B only. Column C is the calculated total of these entries.)

Line 12. Reporting Period - Expenditures of Adoption Savings On Other Title IV-B or Title IV-E Allowable Services (from line 8 amount) – This line consists of the actual title IV-E agency expenditures (without federal matching funds) of calculated cumulative adoption savings for the purposes of providing title IV-B or title IV-E allowable services other than those specified for reporting on lines 10 and 11 of this Part. Amounts reported include expenditures made in the current FFY (in Column A) and any expenditures made in a prior FFY subject to Part 4 reporting (Column B) that have either not previously been reported on a Part 4 submission or are adjustments to amounts previously so reported.

(Enter amounts directly on this form in Column A and Column B only. Column C is the calculated total of these entries.)

Line 13. Reporting Period - Total Expenditures of Calculated Adoption Savings (lines 10 + 11 + 12) – This line represents the total amount of title IV-E agency expenditures (without federal matching funds) reported in this FFY reporting period designated as expenditures of calculated cumulative adoption savings. The amounts reported in each column are calculated from the sum of the amount on lines 10, 11 and 12 in this Part.

(No entries are required. All columns are calculated as noted above.)

Line 14. Cumulative - Total Expenditures of Calculated Adoption Savings (lines 9 + 13) – This line represents the cumulative total for all Part 4 reporting periods of title IV-E agency expenditures (without federal matching funds) designated as expenditures of calculated cumulative adoption savings. The amounts reported in each column are calculated from the sum of the amount on lines 9 and 13 in this Part.

(No entries are required. All columns are calculated as noted above.)

Line 15. Prior Reported FFYs - Unexpended Balance of Calculated Adoption Savings (line 1 – line 9) – This line identifies the portion of the cumulative total of Part 4 previously reported adoption savings calculated before the current FFY that were not reported as expended in a prior FFY. It thus establishes the full balance of reported adoption savings available for expenditure by the title IV-E agency as of the end of the prior FFY. Since only prior FFYs are addressed, a calculation is made only in column B. This entry is the calculated difference between the entry on line 1 and line 9. The same entry is also shown in Column C. This total should equal the amount calculated on the immediately prior FFY Part 4 report (if any) on line 16 in Column C since it reflects amounts from all previous reports.

(No entries are required. Columns B and C are calculated as noted above.)

Line 16. Reporting Period - Unexpended Balance of Calculated Adoption Savings (line 7 – line 13) – This line identifies the portion of the calculated adoption savings reported on this Part 4 submission (both as Current FFY and as Prior Reported FFYs) that were not reported as expended on this Part 4 submission. It thus establishes the portion of newly identified adoption savings that have been expended before the close of the current FFY. Since there may be an unexpended balance of adoption savings from a prior FFY which is expended in the current FFY, it is possible that the calculated amounts can contain a negative number (i.e. reported expenditures exceed reported adoption savings). Columns A and B entries are the calculated difference between the entries on lines 7 and 13. Column C is calculated as the total of columns A and B.

(No entries are required. All columns are calculated as noted above.)

Line 17. Cumulative - Unexpended Balance of Calculated Adoption Savings (line 15 + line 16) – This line identifies the cumulative portion of the calculated adoption savings reported on all Part 4 submissions that were not reported as expended. It thus also establishes the portion of identified cumulative adoption savings that have been expended before the close of the current FFY. The amounts reported in each column are calculated from the sum of the amount on lines 15 and 16 in this Part.

(No entries are required. All columns are calculated as noted above

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