OCSE Form 34-A

Page 10

OCSE-Form 34A, September 26, 2003

INSTRUCTIONS FOR COMPLETION OF FORM OCSE-34A

Paperwork Act Notice. This information collection is mandatory. The information collected on this form is required under Title IV-D (Sections 455 and 457) of the Social Security Act (42 USC 655 and 657). The Office of Child Support Enforcement uses this information to calculate and issue quarterly Federal grant awards and annual incentive payments to the State agencies administering the Child Support Enforcement Program. This is considered public information and is published in an annual report of statistical and financial data available to the public. States are not required to use this form if it does not include a currently valid OMB Control Number.

Reporting Burden Notice. The reporting burden imposed by the collection of information required by this report is estimated to be 8 hours per response. This includes time for reviewing instructions, searching data sources, gathering and maintaining the data needed and completing and reviewing the information reported.

State agencies administering the Child Support Enforcement program under title IV-D of the Social Security Act are required to complete and submit this report quarterly in accordance with instructions issued by the Office of Child Support Enforcement (OCSE).

Due Dates: This report must be submitted within thirty days of the end of each fiscal quarter, i.e., no later than October 30, January 30, April 30 and July 30.

Revisions: If the State needs to change or correct the reported collections, a revised report may be submitted. However, a revised report will not be accepted after the collections reported in the original submission have been used in the calculation of a quarterly grant award. Any revised report must be submitted no later than 90 days following the end of the quarter (i.e., no later than March 31, June 30, September 30 or December 31). Any additional changes to the reported collections that must be reported after that time must be included as an adjustment on a subsequent collection report.

No re-submissions, revisions or adjustments of collection reports submitted for any quarter of the fiscal year will be accepted by OCSE later than December 31 - 3 months after the end of the fiscal year.

Only data received by OCSE as of that date will be used in the calculation of incentive payments and in the publication of statistical data.

Distribution: A copy with original signatures must be sent to:

Administration for Children and Families

Office of Grants Management

Division of Mandatory Grants

Att’n: Child Support Enforcement

370 L’Enfant Promenade, SW

Washington, DC 20447

An additional copy must be sent to the ACF Regional Administrator.

General Instructions:

- Round all entries to the nearest dollar; omit cents.

- Enter the State name.

- Enter the ending date of the quarter for which these collections are being reported.

- Check box to indicate whether this is the initial report for the quarter indicated or a revision of a previously submitted report.

Definitions:

Collections Received. A child support payment is considered to be collected and received on the date it arrives at the State Disbursement Unit or, if applicable, at any formerly designated State-level or county-level collection point via mail, private courier, electronic transfer or hand delivery. If elected by the State, the date of withholding by an employer may be deemed to be the date of collection and receipt. Any amounts received and reasonably identifiable as a child support collection under title IV-D must be reported on Line 2 of this form, even if an individual amount cannot be immediately associated with a specific title IV-D case. Any amount paid in advance of its due date (a "prepaid" or “future” collection) must also be reported on Line 2 in the quarter received, even if it is known that distribution and disbursement will not occur until a later quarter.

Collections Distributed and Disbursed. The procedure for distributing collections is described under Section 457 of the Social Security Act. Distribution is the identification and allocation or apportionment of a support collection to current and past-due support, as applicable, of a specific case or individual. Disbursement is the actual process of dispensing or paying out the collection. Distribution under Section 457 of the Act requires disbursement of a collection according to a specified allocation. All title IV-D collections and all Non-IV-D collections that meet the definition found on Line 2f of this reporting form are subject to the distribution requirements found in Section 457.

In accordance with the definitions above and for the purposes of reporting on this form, to be considered “Distributed” under Section 457 of the Act (and to be reported as such on Lines 7a through 8, as appropriate, of this reporting form), a collection must be both distributed and disbursed. Any collection that has been distributed (i.e., “identified and allocated or apportioned”) but not disbursed (i.e., “dispensed or paid out”) is considered “Undistributed” under Section 457 (and is reported as such on Lines 9 through 9d, as appropriate, of this reporting form).

A collection is considered disbursed on the date the funds are forwarded via check, electronic transfer or other means to the intended final recipient, including the custodial family, State or Federal agency, including those agencies that administer programs under titles IV-A, IV-E and XIX of the Social Security Act.

If a check used to disburse a collection is returned as undeliverable or remains uncashed and is considered “stale,” that amount can no longer be considered to be “disbursed.” In that instance, the amount of collections designated as "distributed and disbursed" must be reduced accordingly and the amount redesignated as Undistributed until another disbursement can be attempted. (See additional instruction below and instruction for Line 9d.)

In instances where it is known that a case has changed its status between the date a collection is received and the date of distribution and disbursement (e.g., from Former to Current Assistance or vice versa), report the amount distributed in Column A through F in accordance with the case status as of the date of receipt of the collection.

Column A: Current IV-A Assistance. Collections received and distributed on behalf of children who are recipients of Temporary Assistance for Needy Families (TANF) under title IV-A of the Act. In addition, the children's support rights have been assigned to the State and a referral to the State's IV-D agency has been made.

Column B: Current IV-E Assistance. Collections received and distributed on behalf of children who are entitled to Foster Care maintenance assistance payments under title IV-E of the Social Security Act. In addition, the children's support rights have been assigned to the State and a referral to the State IV-D agency has been made.

Column C: Former IV-A Assistance. Collections received and distributed on behalf of children who formerly received assistance under title IV-A (TANF or Aid to Families with Dependent Children [AFDC]) of the Social Security Act.

Column D: Former IV-E Assistance. Collections received and distributed on behalf of children who formerly received assistance under title IV-E (Foster Care) of the Social Security Act.

Column E: Medicaid Never Assistance. Collections received and distributed on behalf of children who are receiving Child Support Enforcement services under title IV-D of the Social Security Act, and who are either currently receiving or who have formerly received Medicaid payments under title XIX of the Social Security Act, but who are not currently receiving and who have never formerly received assistance under either title IV-A (TANF or AFDC) or title IV-E (Foster Care) of the Social Security Act.

Column F: Other Never Assistance. Collections received and distributed on behalf of children who are receiving Child Support Enforcement services under title IV-D of the Social Security Act, but who are not currently receiving and have never formerly received either Medicaid payments under title XIX or assistance under either title IV-A (TANF or AFDC) or title IV-E (Foster Care) of the Social Security Act.

Column G: Total. Enter, where applicable, the sum of the amounts entered in Columns A through F.

IV-D Case. Any child support enforcement case in which the custodial parent has either assigned his or her rights to receive support payments to the State as a condition of receiving assistance (either as a current or former recipient of such assistance) or has filed an application for services available under Title IV-D. Although a limited amount of Federal funding is available to compile data, maintain registers and process payments for non-IV-D cases that do not meet these criteria, such cases are not considered “IV-D cases.”

Non-IV-D Case. Any child support enforcement case in which the custodial parent has neither assigned his or her rights to receive support to the State nor has filed an application for services available under Title IV-D.

FMAP Rate. The Federal Medical Assistance Percentage Rate applicable to each State as defined in Section 1905(b) of the Social Security Act. This rate, not less than 50 percent, is based on the ratio of the per capita income in each State to that of the United States and is reassessed and published in the Federal Register annually. (In accordance with Section 457(c)(3)(A) of the Social Security Act, the rate is fixed at 75 percent for Puerto Rico, Guam and the Virgin Islands.)

Line-by-Line Instructions:

Line Item

Line Description

Edit Check

1.

Balance Remaining Undistributed From Previous Quarter. The amount of collections that remained undistributed at the end of the previous quarter.

Line 9b, prior quarter report

2.

Total Collections Received During the Quarter. All collections received by the State from various sources, including those amounts that will be forwarded on to other States.

Sum of Lines 2a - 2g

	SPECIAL REPORTING INSTRUCTION for LINES 2a through 2g Amounts reported on Lines 2a through 2g must be "net" amounts, reduced by any collections returned to the payer during the quarter. For example, the amount reported as Federal Tax Refund Offset would be reduced by any collected amount returned to the payer, including any amount reported as a repayment on Line 14 of Form OCSE-396A.
2a.	From the Offset of Federal Tax Refunds. Amounts received on behalf of IV-D cases as a result of the IRS' offset of Federal income tax refunds. Report the full amount of the collection, prior to the reduction for the FMS service fee. The FMS service fee may be claimed as an expense on Form OCSE-396A. (Do not include amounts received through the IRS "full collection" process.)	Direct Entry
2b.	From the Offset of State Tax Refunds. Amounts received on behalf of IV-D cases as a result of the offset of State income tax refunds.	Direct Entry
2c.	From the Offset of Unemployment Compensation Payments. Amounts received on behalf of IV-D cases as a result of the offset of unemployment compensation insurance payments.	Direct Entry
2d.	Through Procedures for the High Volume, Automated Administrative Enforcement in Interstate Cases (AEI). Amounts received on behalf of IV-D cases as the "assisting State" for AEI requests in accordance with Section 466(a)(14) of the Social Security Act. (Any amount reported on this line will be forwarded to another State during the current quarter or in a subsequent quarter.)	Direct Entry
2e.	From IV-D and Non-IV-D Income Withholding. Amounts received on behalf of IV-D cases through either voluntary or involuntary income withholding, including withholding actions initiated prior to the effective date of Section 466(a)(1) of the Social Security Act. Also include amounts received through income withholding on behalf of Non-IV-D cases pursuant to Section 466(a)(8)(B) of the Social Security Act and where a support order was initially issued on or after January 1, 1994.	Direct Entry
.
2f.	From Other States. Amounts received on behalf of IV-D cases from another State. Include any amounts received as the “initiating” State either in Interstate or AEI cases. Any fees or recovered costs retained by the other State are reported on Line 13 and are not included in this amount.	Direct Entry
2g.	From Other Sources. All other amounts - not reported above – received on behalf of IV-D cases through the State's own collections procedures. This includes, but is not limited to: (a) payments received directly from non-custodial parents; (b) collections received through the IRS' full collection process; (c) collections received as a result of the administrative offset process; and (d) collections received through the Financial Institution Data Match. For “administrative offset” collections, report the full amount of the collection, prior to the reduction for the FMS service fee. The FMS service fee may be claimed as an expense on Form OCSE-396A.	Direct Entry

3.	Net Amount of Increasing and Decreasing Adjustments. Any entry necessary to correct a previous report that cannot be corrected with an entry on the original reporting line. This line will frequently remain blank. An entry on this line may be a negative number. Any entry on this line must be explained with a footnote or attachment.	Direct Entry
4.	Collections Forwarded to Non-IV-D Cases. Those collections, received through income withholding on behalf of Non-IV-D cases and processed through the State Disbursement Unit, that were forwarded to the custodial parent during the quarter.	Direct Entry
5.	Collections Forwarded to Other States. Amounts received in response to a request for assistance from another State and forwarded during the quarter to that State for distribution, including interstate cases and AEI collections. (These amounts are included in the entries made on lines 2a through 2g.) (The amounts reported on this line are used in the annual incentive payment calculation, including “double counting” of entries in Cols. A through E for the State Collection Base computation.)	Direct Entry

6.

Total Collections Available for Distribution. The total amount of collections eligible for distribution by the State during the quarter, including those amounts received during the quarter and those amounts remaining undistributed from a previous quarter. (Enter only Total amount in Column G.)

Sum of Lines 1+2+3 minus Sum of Lines 4+5.

7a.

Collections Distributed As Assistance Reimbursement. Collections that will be divided between the State and Federal governments to reimburse their respective shares of either Title IV-A assistance payments or Title IV-E Foster Care maintenance payments. (Note: No entry is to be made for "Never Assistance" cases, Columns E and F.)

Direct Entry

7b.

Collections Distributed As Medical Support Payments. The portion of any collection that corresponds to any amount specifically designated in a support order for medical support. To the extent that medical support has been assigned to the State, medical support collections must be forwarded to the Medicaid agency for distribution in accordance with current regulations under title XIX of the Social Security Act (Medicaid). Otherwise, the amount must be forwarded to the family.

Direct Entry

7c.

Collections Distributed To The Family or Foster Care. Collections not included on either Line 7a or 7b that are distributed either to the family or to the foster care agency to be used on the child’s behalf. Report on this line any collections distributed to the family, but assigned by the family and forwarded to another State agency (e.g., a State-run Foster Care or Child Care program). Also report on this line, collections distributed to the family but sent, at the direction of the family, to the address of a private collection agency.

Direct Entry

8.

Total Collections Distributed During the Quarter. Collections distributed by the State during the quarter, itemized by case designation. (The amounts reported on this line are used in the annual incentive payment calculation, including “double counting” of entries in Cols. A through E for the State Collection Base computation.)

Sum of Lines 7a through 7c

“Stale”/Uncashed Disbursements

On occasion, a check sent to a custodial parent as a disbursement of a child support payment is either not cashed in a timely manner and is considered “stale” and no longer negotiable, or is returned uncashed to the State as undeliverable. In these instances, the State must reverse the distribution transaction by including a negative adjustment on Line 7c in the quarter in which the check becomes “non-negotiable” or is received back by the State, and included in the undistributed amounts reported on Lines 9b and 9d.

9.

Gross Undistributed Collections. The amount of collections that the State was unable to distribute during the quarter. (Enter only Total amount in Column G.)

Line 6 minus Line 8 or Sum of Lines 9a and 9b

9a.	Undistributed Collections Determined Undistributable and Abandoned. The portion of collections reported on Line 9 that, despite numerous attempts, the State has determined it will be unable to distribute in accordance with the provisions of Section 457 of the Social Security Act and unable to return to the non-custodial parent. Under State law, these amounts are considered to be "abandoned property." If State law does not require that abandoned property be identified each quarter, this line may be left blank in quarters where such a determination is not made. This amount is considered "program income" and must be included in the entry reported on Line 2b of Form OCSE-396A, the "Quarterly Report of Expenditures for the Child Support Enforcement Program." (This entry must only be reported as a positive number.) (Enter only Total amount in Column G.)	Direct Entry
9b 9c.	Net Undistributed Collections. The amount of collections that remain available for distribution in a future quarter. (Enter only Total amount in Column G.) Undistributed Collections Pending Distribution. The portion of net undistributed collections reported on Line 9b that have been identified and allocated to a particular account and which the State reasonably expects to distribute and disburse through normal processing at a date certain or a date determined by law in the near future. These undistributed collections include, but are not limited to: collections that were received within the past two business days following receipt, and pending distribution within federal timelines; collections being held for up to six months that were offset from refunds from joint Federal tax returns of Non-TANF families; collections received and held for future support; collections held pending resolutions of a legal dispute and any timely appeal (including but not limited to estate resolutions; contested paternity; contested tax, insurance, and pension intercepts; arrearage balance disputes; contested bank levies; contested seizures of lottery winnings, and other lump-sum seizures; etc.) collections processed, but not yet transferred to other state or federal agencies administering programs such as TANF, IV-E and non-IV-E (foster care), Medicaid, or S-CHIP. (Enter only Total amount in Column G.)	Line 9 minus 9a Also: Sum of Lines 9c and 9d Direct Entry
9d 10a. 10b. 11.	Undistributed Collections Unresolved. The portion of net undistributed collections reported on Line 9b that either have not been fully identified or allocated and do not have a definite disbursement date due to insufficient information. These undistributed collections include, but are not limited to: (i) unidentified collections; collections pending the location of the custodial or noncustodial parent; collections initially disbursed by check that remains uncashed and is now considered stale-dated and non-negotiable in accordance with State law and procedures; collections with inaccurate or missing information, including, but not limited to, information to be supplied by an employer or where the amount of the payment does not equal the transmittal amount; collections received on cases with no open or active account; and other data issues; Other collections remaining undistributed. (Enter only Total amount in Column G.) Federal Share of IV-E Collections.    The portion of child support collections used to reimburse the Federal government for its share of past assistance payments under title IV-E of the Social Security Act.   (Note: Enter amounts only in Columns B and D, plus the Total in Column G.)  The Total amount entered in Column G is carried forward and entered on Part I, Line 2, Column (b), of Form IV-E-1, “Title IV-E Foster Care and Adoption Assistance Financial Report.” Federal Share of IV-A Collections. The portion of child support collections used to reimburse the Federal government for its share of past assistance payments under title IV-A of the Social Security Act. (Note. Enter amounts only in Columns A and C, plus the Total in Column G.) Estimated Incentive Payments Retained by the State. Enter an amount equal to approximately one-quarter of the estimated annual incentive payment. (The sum of the entries made on the four quarterly reports for a single fiscal year must not exceed the total annual incentive payment estimate.) (Enter only Total amount in Column G.)	Direct Entry Columns B & D: Line 7a x FMAP rate for the reporting quarter Columns A & C: Line 7a x FMAP rate for the reporting quarter Direct Entry

12. 13.

Quarterly Grant Adjustment. The amount to be included on the next Title IV-D grant award as an adjustment to recoup the Federal share of collections and to pay the quarterly estimate of the State’s annual incentive payment. (Note: This amount is carried forward and entered on Line 10, Column B of Part 1 of Form OCSE-396A, the “Quarterly Report of Expenditures and Estimates” for the Child Support Enforcement Program.) (Enter only Total amount in Column G.) Fees Retained by Other States. The amount of fees or costs recovered by other States from collections forwarded to the reporting State. The net amount of the collection forwarded is reported on Line 2f. Amounts entered on this line are not included on any other line of this report. (Enter only Total amount in Column G.) (The amount reported in this entry is used in the annual incentive payment calculation.)

Line 10b minus Line 11 Direct Entry (Information from other State)

Signatures: This report must be signed and dated by the State Title IV-D Director, or other State official responsible for the financial administration of the child support enforcement program. Although under Federal requirements only a single signature is necessary, space is also provided for a second signature as may be required by State law, regulation or policy. Any individual(s) signing this report are certifying to the correctness and accuracy of the information here and on accompanying documents.