IV-E Foster Care and Adoption Assistance Quarterly Financial Report

Forms and Documents

Document Name	Status
Form CB-496 Form CB-496, "Title IV-E Program Quarterly Financial Report Form	Modified
Supporting Statement - Form CB-496 - July 2015 - Oct 2015 UPDATE (00000003).docx Supporting Statement A	2015-10-19

IC Document Collections

IC ID	Document Title	Status
10037	Form CB-496, "Title IV-E Program Quarterly Financial Report Form	Modified

ICR Details

OMB Control No: 0970-0205	ICR Reference No: 201507-0970-008
Status: Historical Active	Previous ICR Reference No: 201306-0970-003
Agency/Subagency: HHS/ACF	Agency Tracking No: OA
Title: IV-E Foster Care and Adoption Assistance Quarterly Financial Report
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/21/2015
	Date Received in OIRA: 08/04/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2018	36 Months From Approved	08/31/2016
Responses	268	0	248
Time Burden (Hours)	5,628	0	4,960
Cost Burden (Dollars)	0	0	0

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Abstract: This form is used by States (including DC and PR)and Tribes to report the Total and Federal share of program expenditures made during the preceding quarter and to report the estimated Total and Federal share of the same expenditures to be made in the upcoming quarter for the Foster Care, Adoption Assistance and Guardianship Assistance programs under Title IV-E of the Social Security Act. This information is used to calculate quarterly grant awards and the collected data is available to the general public. Respondents are limited to the designated Title IV-E agency in each State or Tribe.

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Authorizing Statute(s): PL: Pub.L. 110 - 351 101 Name of Law: Fostering Connections to Success and Increasing Adoptions Act of 2008
  

Citations for New Statutory Requirements: PL: Pub.L. 113 - 183 473 Name of Law: Preventing Sex Trafficking and Strengthening Families Act

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 1663	03/30/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 43093	07/02/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Form CB-496, "Title IV-E Program Quarterly Financial Report	CB-496	Quarterly Financial Report

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	268	248	0	20	0	0
Annual Time Burden (Hours)	5,628	4,960	0	668	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Burden increase due to program change in the instrument and instructions.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/04/2015

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