CFS-101 Annual Budget Expenses Request and Est. Expenditures

Child & Family Services Plan (CFSP). Annual Progress & Services Report (APSR), & Annual Budget Expenses Request & Estimated Expenditures (CFS-101)

CFS-101 - 3-17-08.xls

CFS-101, Parts I, II, and III

OMB: 0970-0426

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Overview

Part I
Part II
Part III

Sheet 1: Part I
CFS-101, Part I: Annual Budget Request for Title IV-B, Subpart 1 & 2 Funds, CAPTA, CFCIP, and ETV
Fiscal Year 20__, October 1, 20__ through September 30, 20__


1. State or ITO: 2. EIN:
3. Address: 4. Submission:
[ ] New
[ ] Revision
5. Total estimated title IV-B, Subpart 1 Funds $
a) Total administration (not to exceed 10% of estimated allotment) $
6. Total estimated title IV-B, Subpart 2 Funds (FOR STATES: This amount should equal the sum of lines a-g. ITOs are not required to complete lines 6a-6g.) $
    a) Total Family Preservation Services $
    b) Total Family Support Services $
    c) Total Time-Limited Family Reunification Services $
    d) Total Adoption Promotion and Support Services $
    e) Total for Other Service Related Activities (e.g. planning) $
    f) Monthly Caseworker Visits (STATES ONLY) $
    g) Total administration (FOR STATES: not to exceed 10% of estimated allotment) $
7. Re-allotment of Title IV-B, Subpart 2 funds for State and Indian Tribal Organizations
a) Indicate the amount of the State’s/Tribe’s allotment that will not be required to carry out the Promoting Safe and Stable Families program. $______________
b) If additional funds become available to States and ITOs, specify the amount of additional funds the State or Tribe is requesting. $_________________
8. Child Abuse Prevention and Treatment Act (CAPTA) State Grant (no State match required)
Estimated Amount $_________, plus additional allocation, as available.
9. Estimated Chafee Foster Care Independence Program (CFCIP) funds. (FOR STATES ONLY) $
a) Indicate the amount of State's allotment to be spent on room and board for eligible

$
youth (not to exceed 30% of CFCIP allotment).


10. Estimated Education and Training Voucher (ETV) funds. $
11. Re-allotment of CFCIP and ETV Program Funds:
a) Indicate the amount of the State’s allotment that will not be required to carry out CFCIP $___________.
b) Indicate the amount of the State’s allotment that will not be required to carry out ETV $___________.
c) If additional funds become available to States, specify the amount of additional funds the State is requesting for CFCIP $________________ for ETV program $_________________________.
12. Certification by State Agency and/or Indian Tribal Organization.
The State agency or Indian Tribe submits the above estimates and request for funds under title IV-B, subpart 1 and/or 2, of the Social Security Act, CAPTA State Grant, CFCIP and ETV programs, and agrees that expenditures will be made in accordance with the Child and Family Services Plan, which has been jointly developed with, and approved by, the ACF Regional Office, for the Fiscal Year ending September 30, 20__.
Signature and Title of State/Tribal Agency Official Signature and Title of Central Office Official

Sheet 2: Part II
CFS-101 Part II: Annual Summary of Child and Family Services










State or ITO ______________________________ For FFY OCTOBER, ____ TO SEPTEMBER 30, ____











TITLE IV-B (c) (d) (e) (f) (g) (h) (i) (j)
CAPTA* CFCIP* ETV* TITLE IV-E State, Local, & Donated Funds NUMBER TO BE SERVED POPULATION TO BE SERVED GEOG. AREA TO BE SERVED
SERVICES/ACTIVITIES (a) I-CWS (b) II-PSSF




Individuals Families

1) PREVENTION & SUPPORT SERVICES (FAMILY SUPPORT) Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell
2) PROTECTIVE SERVICES Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell
3) CRISIS INTERVENTION (FAMILY PRESERVATION) Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell
4)TIME-LIMITED FAMILY REUNIFICATION SERVICES Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell
5.) ADOPTION PROMOTION AND SUPPORT SERVICES Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell
6) FOSTER CARE MAINTENANCE: Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell
(a) FOSTER FAMILY & RELATIVE FOSTER CARE
(b) GROUP/INST CARE Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell
7) ADOPTION SUBSIDY PMTS. Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell
8) INDEPENDENT LIVING SERVICES Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell
9) EDUCATION AND TRAINING VOUCHERS Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell
10) ADMINISTRATIVE COSTS Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell
11) STAFF TRAINING Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell
12) FOSTER PARENT RECRUITMENT & TRAINING Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell
13) ADOPTIVE PARENT RECRUITMENT & TRAINING Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell
14) CHILD CARE RELATED TO EMPLOYMENT/TRAINING Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell
15) MONTHLY CASEWORKER VISITS Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell

Blank Cell Blank Cell Blank Cell Blank Cell
16) TOTAL Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell Blank Cell












* States Only, Indian Tribes are not required to include information on these programs










Sheet 3: Part III
CFS-101, PART III: Annual Expenditures for Title IV-B, Subparts 1 and 2, Chafee Foster Care Independence (CFCIP) and Education And Training Voucher (ETV) : Fiscal Year 2006: October 1, 2005 through September 30, 2006
1. State or ITO: 2. EIN: 3. Address:
4. Submission: [ ] New [ ] Revision
Description of Funds Estimated Expenditures Actual Expenditures Number served Population served Geographic area served
Individuals Families
5. Total title IV-B, subpart 1 funds $ $ Blank Cell Blank Cell Blank Cell Blank Cell
a) Total Administrative Costs (not to exceed 10% of Federal allotment) $ $ Blank Cell Blank Cell Blank Cell Blank Cell
6. Total title IV-B, subpart 2 funds (This amount should equal the sum of lines a - g.) $ $
Blank Cell Blank Cell Blank Cell
a) Family Preservation Services $ $ Blank Cell Blank Cell Blank Cell Blank Cell
b) Family Support Services $ $ Blank Cell Blank Cell Blank Cell Blank Cell
c) Time-Limited Family Reunification Services $ $ Blank Cell Blank Cell Blank Cell Blank Cell
d) Adoption Promotion and Support Services $ $ Blank Cell Blank Cell Blank Cell Blank Cell
e) Total for Other Service Related Activities (e.g. planning) $ $ Blank Cell Blank Cell Blank Cell Blank Cell
f) Monthly Caseworker Visits (FOR STATES) $ $



g) Total Administrative Costs (FOR STATES: not to exceed 10% of total allotment after October 1, 2007) $ $ Blank Cell Blank Cell Blank Cell Blank Cell
7. Total Chafee Foster Care Independence Program (CFCIP) funds $ $ Blank Cell Blank Cell Blank Cell Blank Cell
a) Indicate the amount of State’s allotment spent on room and board for eligible youth (not to exceed 30% of CFCIP allotment) $ $ Blank Cell Blank Cell Blank Cell Blank Cell
8. Total Education and Training Voucher (ETV) funds $ $ Blank Cell Blank Cell Blank Cell Blank Cell
9. Certification by State Agency or Indian Tribal Organization (ITO). The State agency or ITO agrees that expenditures were made in accordance with the Child and Family Services Plan, which has been jointly developed with, and approved by, the Children's Bureau, for the Fiscal Year ending September 30, 20__.
Signature and Title of State/Tribal Agency Official Date Signature and Title of Central Office Official Date
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