Prog;ram Instruction

Temporary Assistance for
Needy Families
Program Instruction

U.S. Department of Health and Human Services
Administration for Children and Families
Office of Family Assistance
Washington, DC 20447

No. TANF-ACF-PI-2011-

Date: October , 2011

TO:

State agencies administering child welfare and public assistance programs

SUBJECT:

Form ACF-4125, Children in Foster Homes and Children in Families
Receiving Payments in Excess of the Poverty Income Level from a State
Program Funded Under Part A of Title IV of the Social Security Act

REFERENCES:

Section 1124(c)(4) of Title I of the "Elementary and Secondary Education
Act of 1965," as amended by Public Law 103-382, the “Improving
America’s Schools Act of 1994"; Section 110(j) of Public Law 104-193,
the "Personal Responsibility and Work Opportunity Reconciliation Act of
1996"; and Public Law 107-110, the “No Child Left Behind Act”

PURPOSE:

To request October 2011 caseload data for the number of foster children
supported with public funds and the number of children in families
receiving Temporary Assistance for Needy Families (TANF) payments in
excess of the poverty income level

BACKGROUND:
The Secretary of Health and Human Services must collect and transmit to the Secretary of
Education the caseload data concerning the number of children who, in the month of October,
were: (1) living in foster homes supported by public funds; or (2) receiving payments in excess
of the poverty income level from a State TANF program. The data collected constitute a part of
the formula used by the Department of Education to allocate school year 2011-2012 grants to
local educational agencies (LEAs) under Title I, Part A of the Elementary and Secondary
Education Act to meet the special educational needs of educationally deprived children.
Payments in excess of the poverty income level are public assistance payments that exceed the
amounts listed below and that are made under the TANF program from Federal, State, and/or
local funds. The monthly poverty income level is derived from the 2011 HHS Poverty
Guidelines, a simplified version of the Federal Government’s statistical poverty thresholds issued
by the Bureau of the Census. For this report, the level is set at 1/12 of the annual poverty
threshold for a non-farm family of four. Applicable amounts for the October 2011 report are:
$1,862.50 for all 48 contiguous States and the District of Columbia
$2,328.34 for Alaska
$2,142.50 for Hawaii

SUBMITTAL PROCEDURE:
Please ensure that the data provided include the name of the LEA [or county, if not available
by LEA] and reporting code shown on the list. Form ACF-4125 must be submitted by
December 31, 2011, failure to do so will result in the loss of Title I funds.
Please submit this report to the Administration for Children and Families in Washington, DC, via
regular mail, e-mail, or FAX (electronic submittal is preferred). Addresses are provided in the
Instructions. In addition, please send one copy to the appropriate ACF Regional Office.
Please include the contact information (name, telephone number and email address) of the person
who compiled the report on the front page.
ATTACHMENTS:
Form ACF-4125 [OMB Number 0970-0004] and Instructions. All attachments and individual
State workbooks are also available on the Office of Family Assistance’s Home Page:
http://www.acf.hhs.gov/programs/ofa/data-reports/ACF4125/FormACF.htm.
INQUIRIES:
If you have questions or need further information, please contact the Administration for Children
and Families/Office of Family Assistance/Division of Data Collection and Analysis:
Paulette Bowen
Phone: 202/401-9251
FAX: 202/401-5554
FAX: 202/205-5887
E-mail: [email protected]
Mail: 370 L'Enfant Promenade, SW
ACF/OFA, 5th Floor East
Washington, DC 20447
OR
Yun Song
Phone: 202/401-5293
FAX: 202/401-5554
FAX: 202/205-5887
E-mail: [email protected]
Mail: 370 L'Enfant Promenade, SW
ACF/OFA, 5th Floor East
Washington, DC 20447

Earl S. Johnson
Director
Office of Family Assistance