Form CFS-101, Part 1, S CFS-101, Part 1, S CFS-101, Part 1: Annual Budget Request for Title IV-B, S

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

CFS-101s Instructions and Forms

CFS-101, Parts I, II, and III

OMB: 0970-0426

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0970-0426 can be found here:

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CFS-101, PART I

U.S. Department of Health and Human Services
Administration for Children and Families

Attachment B

OMB Approval #0970-0426
Approved through September 30, 2017

CFS-101, Part I: Annual Budget Request for Title IV-B, Subpart 1 & 2 Funds, CAPTA,
CFCIP, and ETV Instructions
Note: While the information on the programs are consolidated into one Child and Family
Services Plan (CFSP), eligibility and expenditure reports for the individual programs are
separate. Funding will not be delayed for one program due to potential eligibility issues in another
program.
Complete separate forms for each fiscal year.
1. State or ITO: Enter the name of the State or Indian Tribal Organization (ITO).
2. EIN: Indicate the Employer Identification Number (EIN).
3.

Address: Enter the address of the State or ITO Agency.

Submission: Indicate if this is a NEW submission for the upcoming Fiscal Year, or a
REVISION of the budget request for the current year.

5.
Total estimated title IV-B, subpart 1 funds: Specify the estimated amount of title IV-B,
subpart 1 Federal funds that the State or ITO expects to spend during the fiscal year on the
Stephanie Tubbs Jones Child Welfare Services (CWS) Program. The previous Federal Fiscal
Year’s (FFY) final allotment as provided in the annual Program Instruction on the Annual
Progress and Services Report (APSR) or CFSP is to be used as the estimated amount for the
State’s/Tribe’s request. 1 A 25% match is required and the State or Tribe’s match amount should
be reflected on the SF-425 report.
a) Specify the estimated amount of title IV-B, subpart 1 CWS funds entered on line 5 to be
spent on administration (not to exceed 10% of the total title IV-B, subpart 1 estimated
allotment).
6.
Total estimated title IV-B, subpart 2 funds: Specify the total estimated amount of title
IV-B, subpart 2 Federal funds that the State or ITO expects to spend during the fiscal year on the
Promoting Safe and Stable Families (PSSF) Program. The previous Federal Fiscal Year’s (FFY)
final allotment as provided in the annual Program Instruction on the APSR or CFSP is to be used
as the estimated amount for the State’s/Tribe’s request. A 25% match is required and the State or
Tribe’s match amount should be reflected on the SF-425 report. Tribes are not required to
complete items 6 a-f.
a) Specify the estimated amount of title IV-B, subpart 2 PSSF funds to be spent during the
fiscal year for Family Preservation Services (a strong rationale must be provided in the
APSR or CFSP if amount is less than 20% of line 6).
1
The tentative allotments for title IV-B, subpart 1 and 2, CFCIP, and ETV are based on the premise that all States
and Indian Tribes will apply for and receive the funds available to them. In the event that not all States or Indian
Tribes apply for or receive their tentative allocations, those funds will be redistributed among eligible States and
Indian Tribes, where permitted by statute. States requesting additional funds in anticipation of such a redistribution
should submit information on the proposed use of such additional funds to the appropriate Children’s Bureau
Regional Office in the State’s/Tribe’s APSR or CFSP.

When States or Tribes that have not applied for funds available to them in past fiscal year(s) decide to do so,
depending upon the total amount of funds appropriated by Congress for the next fiscal year, there may be a reduction
in the final distribution of funds.

CFS-101, PART I

U.S. Department of Health and Human Services
Administration for Children and Families

Attachment B

OMB Approval #0970-0426
Approved through September 30, 2017

b) Specify the estimated amount of title IV-B, subpart 2 PSSF funds to be spent during the
fiscal year for Family Support Services (a strong rationale must be provided in the APSR
or CFSP if amount is less than 20% of line 6).
c) Specify the estimated amount of title IV-B, subpart 2 PSSF funds to be spent during the
fiscal year for Time-Limited Family Reunification Services (a strong rationale must be
provided in the APSR or CFSP if amount is less than 20% of line 6).
d) Specify the estimated amount of title IV-B, subpart 2 PSSF funds to be spent during the
fiscal year for Adoption Promotion and Support Services (a strong rationale must be
provided in the APSR or CFSP if amount is less than 20% of line 6).
e) Specify the estimated amount of title IV-B, subpart 2 PSSF funds to be spent during the
fiscal year for other service related activities (e.g. planning).
f) Specify the estimated amount of title IV-B, subpart 2 PSSF funds to be spent on
administration. (For STATES only, not to exceed 10% of the total title IV-B, subpart 2
estimated allotment.)
7.
Monthly Caseworker Visit title IV-B, subpart 2 funds (for STATES only): Specify
the estimated amount of title IV-B, subpart 2 Monthly Caseworker Visitation (MCV) Federal
Funds the State expects to spend during the fiscal year.
a) Specify the estimated amount of title IV-B, subpart 2 MCV funds entered on line 7a to
be spent on administration (not to exceed 10% of the total title IV-B, subpart 2 MCV
estimated allotment).
8.
Re-allotment of Title IV-B, subparts 1 & 2 funds for State and ITO: The
Administration for Children and Families (ACF) is able to re-allot unneeded portions of State and
Tribal allocations of title IV-B, subparts 1& 2 funds to other States and eligible Indian Tribes so
that the total appropriation remains available for program purposes. In order for a State or ITO to
be awarded a portion of these funds, or for funds to be released, ACF must have on file a request
from the State or Indian Tribe for additional funds, or the release of funds.
a) Indicate the amount of Federal funds of CWS, PSSF and/or MCV (for States only) that
the State or Tribe does not expect to utilize.
b) Indicate the amount of Federal funds of CWS, PSSF and/or MCV (for States only) that
the State or Tribe is requesting, if additional funds become available.
9.
Child Abuse Prevention and Treatment Act (CAPTA) (for STATES only): Indicate
the State’s estimated CAPTA State Grant allocation as provided in the annual Program Instruction
on the APSR. Supplemental funds may be available for distribution if there are States that are not
awarded grant funds or there are unobligated funds available for redistribution. No matching
funds are required for this grant.

CFS-101, PART I

U.S. Department of Health and Human Services
Administration for Children and Families

Attachment B

OMB Approval #0970-0426
Approved through September 30, 2017

10.
Estimated Title IV-E Chafee Foster Care Independence Program (CFCIP) Funds:
Indicate the estimated amount of CFCIP funds that the State or Tribe expects to spend on
independent living activities as provided in the APSR or CFSP Program Instruction.
a) At State or Tribe option, indicate the estimated amount of the funds entered on line 10 a
to be spent for room and board for eligible youth (not to exceed 30% of total estimated
CFCIP allotment.)
11.
Estimated Title IV-E Funds Allotted under Section 477 for the Education and
Training Vouchers (ETV) Program: Indicate the estimated amount of ETV funds that the State
or Tribe expects to spend on ETV as provided in the APSR or CFSR Program Instruction.
12.
Re-allotment of CFCIP and/or ETV Funds for States or Tribes: The Administration
for Children and Families (ACF) is able to re-allot unneeded portions of State or Tribe allocations
of CFCIP and ETV funds to other States or Tribes so that the total appropriation remains
available for program purposes. In order for a State or Tribe to be awarded portions of these
funds, or for funds to be released, ACF must have on file a request from the State or Tribe for
additional funds, or the release of funds.
a) Indicate the amount of funds that the State or Tribe will not utilize from its allotment to
carry out the CFCIP activities.
b) Indicate the amount of funds that the State or Tribe will not utilize from its allotment to
carry out the ETV program activities.
c) Indicate the amount of funds the State or Tribe is requesting if additional funds become
available for the CFCIP program. A 20% State or Tribe match is required. The State or
Tribe match amount must be reflected on the SF-425 report.
d) Indicate the amount of funds the State or Tribe is requesting if additional funds become
available for the ETV program. A 20% State or Tribe match is required. The State or
tribe match amount must be reflected on the SF-425 report.
13.
Certification: This report must be signed and dated in the spaces provided. The
signature and title of the official of the State agency, or Indian Tribal Organization, with authority
to administer or supervise the administration of title IV-B, subparts 1 and 2 programs and, for
States only, the CAPTA and CFCIP programs, must be included.
By signing this form the State/Tribal official assures that the State/Tribe will meet all applicable
match requirements.

CFS-101, Part I
U. S. Department of Health and Human Services
Administration for Children and Families

Attachment B
OMB Approval #0970-0426
Approved through September 30, 2017

CFS-101, Part I: Annual Budget Request for Title IV-B, Subpart 1 & 2 Funds, CAPTA, CFCIP, and ETV
Fiscal Year 2017, October 1, 2016 through September 30, 2017
1. State or Indian Tribal Organization (ITO):

2. EIN:

3. Address:

4. Submission:
[ ] New
[ ] Revision

5. Total estimated title IV-B Subpart 1, Child Welfare Services (CWS) Funds
a) Total administration (not to exceed 10% of title IV-B Subpart 1 estimated allotment)
6. Total estimated title IV-B Subpart 2, Provides Safe and Stable Families (PSSF) Funds. This
amount should equal the sum of lines a - f.
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) Total administration (FOR STATES ONLY: not to exceed 10% of title IV-Bsubpart 2 estimated
allotment)
7. Total estimated Monthly Caseworker Visit (MCV) Funds (FOR STATES ONLY)

$
$
$
$
$
$
$
$
$
$

a) Total administration (FOR STATES ONLY: not to exceed 10% of estimated MCV allotment)
$

8. Re-allotment of title IV-B subparts 1 & 2 funds for States and Indian Tribal Organizations:
a) Indicate the amount of the State’s/Tribe’s allotment that will not be required to carry out the following programs:
CWS $________________, PSSF $________________, and/or MCV(States only)$________________.
b) If additional funds become available to States and ITOs, specify the amount of additional funds the States or Tribes requesting: CWS
$________________, PSSF $________________, and/or MCV(States only)$________________.
9. Child Abuse Prevention and Treatment Act (CAPTA) State Grant (no State match
required): Estimated Amount plus additional allocation, as available. (FOR STATES ONLY)
10. Estimated Chafee Foster Care Independence Program (CFCIP) funds
a) Indicate the amount of State's or Tribe's allotment to be spent on room and board for
eligible youth (not to exceed 30% of CFCIP allotment)
11. Estimated Education and Training Voucher (ETV) funds

$
$

12. Re-allotment of CFCIP and ETV Program Funds:
a) Indicate the amount of the State's or Tribe's allotment that will not be required to carry out CFCIP
Program
b) Indicate the amount of the State's or Tribe's allotment that will not be required to carry out ETV
Program
c) If additional funds become available to States or Tribes, specify the amount of additional funds the
State or Tribe is requesting for CFCIP Program
d) If additional funds become available to States or Tribes, specify the amount of additional funds the
State or Tribe is requesting for ETV Program

$
$
$
$

13. 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 Children's Bureau.

Signature and Title of State/Tribal Agency Official

Signature and Title of Central Office Official

2017 APSR

CFS-101, PART II

U.S. Department of Health and Human Services
Administration for Children and Families

Attachment B
OMB Approval #0970-0426
Approved through September 30, 2017

CFS-101, PART II: Annual Estimated Expenditure Summary of Child and Family Services
Instructions
Important Note on Completing the CFS-101, Part II Form: Formatting
changes have been made to the spreadsheet for the CFS 101, Part II beginning
with reporting year October 1, 2016 through September 30, 2017. It is
important for states, tribes, and territories to use the updated version of this
form to ensure compliance with Federal requirements to make electronic
information posted on websites accessible to people with disabilities. The
revised form includes cells in columns (a) through (h) that have been
prepopulated with a dash (-). To report data for the cells in these columns,
replace the dash (-) with the appropriate numeric dollar amount. Columns (i)
through (l) have been prepopulated with “NA” (meaning that the item is not
applicable). To report data for the cells in these columns, replace the “NA”
with the applicable information. If no information is being reported in a cell,
the cell should not be changed in any way.
This form summarizes the State Agency's and eligible Indian Tribal Organization’s (ITO) estimated
expenditures on Child and Family Services programs, including the Child Abuse Treatment and
Prevention Act (CAPTA) programs and the Chafee Foster Care Independence Program (CFCIP)
including Education and Training Vouchers (ETV) for the next Federal fiscal year. This
information is an integral part of the Child and Family Services Plan and should be discussed by
the ACF Regional Office, State Agency Representatives, and Tribes. States and Tribes should list
estimated expenditures and other information in the category that best fits their programs.
For each of the services/activities listed, indicate in the appropriate columns the estimated
expenditures by program, the estimated number of clients to be served, the population to be served
and the geographic area to be served.
Services/Activities:
1.
Protective Services: Services designed to prevent or remedy the abuse, neglect, or
exploitation of children. Services include investigation and emergency medical services,
emergency shelter, legal action, developing case plans, counseling, assessment/evaluation of family
circumstances, arranging alternative living arrangements, preparing for foster placement, if needed,
and case management and referral to service providers.
2.
Crisis Intervention (Family Preservation): Services for children and families designed to
help families (including adoptive and extended families) at risk or in crisis. The types of services
within this category include:
•

Pre-placement preventive services programs, such as intensive family preservation
programs, designed to help children at risk of foster care placement remain with their
families, where possible;
1

CFS-101, PART II

U.S. Department of Health and Human Services
Administration for Children and Families

Attachment B
OMB Approval #0970-0426
Approved through September 30, 2017

•

Service programs designed to help children, where appropriate, return to families from
which they have been removed; or be placed for adoption, with a legal guardian, or, if
adoption or legal guardianship is determined not to be appropriate for a child, in some other
planned, permanent living arrangement;

•

Service programs designed to provide follow-up care to families to whom a child has been
returned after a foster care placement;

•

Respite care of children to provide temporary relief for parents and other caregivers
(including foster parents);

•

Services designed to improve parenting skills (by reinforcing parents’ confidence in their
strengths, and helping them to identify where improvement is needed and to obtain
assistance in improving those skills) with respect to matters such as child development,
family budgeting, coping with stress, health, and nutrition;

•

Infant safe haven programs to provide a way for a parent to safely relinquish a newborn
infant at a safe haven designated pursuant to a State law; and

•

Case management services designed to stabilize families in crisis such as transportation,
assistance with housing and utility payments, and access to adequate health care.

3.
Prevention and Support Services (Family Support): Community-based services which
promote the safety and well-being of children and families and are designed to increase the strength
and stability of families (including adoptive, foster, and extended families); to increase parents'
confidence and competence in their parenting abilities; to afford children a safe, stable, and
supportive family environment; to strengthen parental relationships and promote healthy marriages;
and to enhance child development, including through mentoring. These services may include
respite care for parents and other caregivers; early developmental screening of children to assess
the needs of these children and assistance in obtaining specific services to meet their needs;
mentoring, tutoring, and health education for youth; a range of center-based activities (informal
interactions in drop-in centers, parent support groups); services designed to increase parenting
skills; and counseling and home visiting activities.
4.
Time-Limited Family Reunification Services: Services and activities that are provided to
a child who is removed from the child's home and placed in a foster family home or a child care
institution, and to the parents or primary caregiver of such a child, in order to facilitate the
reunification of the child safely and appropriately within a timely fashion, but only during the 15month period that begins on the date that the child, pursuant to section 475(5)(F) of the Social
Security Act (the Act), is considered to have entered foster care. The services and activities are the
following:
• Individual, group, and family counseling.
• Inpatient, residential, or outpatient substance abuse treatment services.
• Mental health services.
2

CFS-101, PART II

U.S. Department of Health and Human Services
Administration for Children and Families

•
•
•
•
•

Attachment B
OMB Approval #0970-0426
Approved through September 30, 2017

Assistance to address domestic violence.
Services designed to provide temporary child care and therapeutic services for families,
including crisis nurseries.
Peer-to-peer mentoring and support groups for parents and primary caregivers;
Services and activities designed to facilitate access to and visitation of children by parents
and siblings; and
Transportation to or from any of the services and activities described above.

5.
Adoption Promotion and Support Services: Services and activities designed to
encourage more adoptions out of the foster care system, when adoptions promote the best interests
of children, including such activities as pre- and post-adoptive services and activities designed to
expedite the adoption process and support adoptive families.
6.
Other Service Related Activities: Planning, service coordination, preparation or follow-up
to service delivery such as the recording of progress notes or other activities, other than direct
services or administration, supporting the delivery of services under the program etc.
7.
care.

Foster Care Maintenance: Expenditures for “room and board” for children/youth in foster

a) Foster Family and Relative Foster Care: Payments to cover food, clothing, shelter, daily
supervision, school supplies, a child's personal incidentals, liability insurance with respect to a
child, and reasonable travel to the child's home for visitation and reasonable travel for the child to
remain in the school in which the child is enrolled at the placement in foster care as well as the cost
of providing these services.
b) Group/Institutional Care: This includes the reasonable costs of administration and the operation
of institutional/group home care that are required to provide food, clothing, shelter, daily
supervision, school supplies, a child's personal incidentals, liability insurance with respect to a
child, and reasonable travel to the child's home for visitation; the cost of reasonable travel for the
child to remain in the same school he or she was attending prior to placement in foster care and the
cost of the items themselves.
8.
Adoption Subsidy Payments: Funds provided to adoptive parents on a recurring and nonrecurring basis to assist in the support of special needs children.
9.
Guardianship Assistance Payments: Funds provided to kinship legal guardians on a
recurring and non-recurring basis to assist in the support of children formerly in foster care placed
in their care.
10.
Independent Living Services: Services designed to help youth expected to remain in
foster care until the age of 18, youth who after age 16 leave foster care for kinship guardianship or
adoption and former foster care recipients between 18 and 21 years of age, make the transition to
self-sufficiency. Services may include: education, career exploration, vocational training, job

CFS-101, PART II

U.S. Department of Health and Human Services
Administration for Children and Families

Attachment B
OMB Approval #0970-0426
Approved through September 30, 2017

placement and retention, training in daily living skills, training in budgeting and financial
management skills, substance abuse prevention, and preventive health activities.
States and Tribes are allowed to expend up to 30 percent of their allotments under the Chafee
Foster Care Independence Program for room and board (including rental deposits, utilities and
other expenses that may be included with rent) for children who have left foster care because they
have attained 18 years of age, and who have not yet attained 21 years of age.
11.
Education and Training Vouchers: Include the amount of funds the State or Tribe plans
to utilize for the Education and Training Vouchers (ETV) program in this line item
12.
Administrative Costs: Include the amount of funds the State or Tribe plans to utilize for
administrative costs.
•

For States and Tribes, administrative costs under title IV-B, subpart 1 may not be more than ten
percent of title IV-B, subpart 1 expenditures. Allowable costs for title IV-B, subpart 1 may
include procurement, payroll processing, personnel functions, management, maintenance and
operation of space and property, data processing and computer services, accounting, budgeting,
auditing, and travel expenses. Applicable costs exclude administrative costs related to the
provision of services by caseworkers or the oversight of programs funded under Title IV-B,
subpart 1 (Section 422(c)(1) of the Act).

•

For States only, administrative costs under title IV-B, subpart 2 (including Monthly Caseworker
Visit grants) may not be more than ten percent of title IV-B, subpart 2 expenditures. Allowable
costs for title IV-B, subpart 2 may include, but are not limited to procurement, payroll
processing, personnel functions, management, maintenance and operation of space and
property, data processing and computer services, accounting, budgeting, and auditing.
Allowable costs may also include indirect costs allocable in accordance with the agency's
approved cost allocation plan (45 CFR 1357.32(h)).

13.
Foster Parent Training and Recruitment: Includes the cost of short-term training to
increase foster parent's ability to provide assistance and support to foster and adoptive children, and
those costs associated with/resulting from the recruitment of potential foster parents.
14.
Adoptive Parent Training and Recruitment: Includes the cost of short-term training to
increase adoptive parent's ability to provide assistance and support to foster and adoptive children,
and those costs associated with/from the recruitment of potential adoptive parents.
15.
Child Care Related to Employment/Training: Includes licensed day care purchased for
the purpose of supporting the employment of one or both of the parents.
16.
Staff and External Partners Training: Includes the cost of short and long-term training
to increase the ability of staff and external partners (other than foster/adoptive parents (see #13 &
#14)) to provide assistance and support to children and families, but does NOT include the costs
specifically related to supporting the monthly caseworker visit requirement (see #17 below).

CFS-101, PART II

U.S. Department of Health and Human Services
Administration for Children and Families

Attachment B
OMB Approval #0970-0426
Approved through September 30, 2017

17.
Caseworker Retention, Recruitment & Training: Includes costs related to supporting
monthly caseworker visits with children who are in foster care under the responsibility of the State,
with a primary emphasis on activities designed to improve caseworker retention, recruitment and
ability to access the benefits of technology.
18.
Total: The total amount of funds estimated for the year (equal to the sum of lines 1 through
18) for each column.

CFS-101, PART II

U.S. Department of Health and Human Services
Administration for Children and Families

Attachment B
OMB Approval #0970-0426
Approved through September 30, 2017

Estimated Expenditures:
Columns A-G.
Indicate for each service/activity the amount to be expended from the
Federal program indicated in columns (a) through (g). Note: Column (g) [Title IV-E] amounts
generally are reportable only for the services and activities described in rows (7) through (17). As
applicable and appropriate, States and Tribes operating title IV-E waiver demonstrations should
also indicate in column (g) the extent to which any title IV-E funding will be expended on child
welfare services and activities described in rows (1) through (6). Unless approved to operate a title
IV-E waiver demonstration, states and tribes may not normally spend title IV-E funds for these
purposes.
Column H.
State, Local, and Donated Funds: Indicate the estimated amount of State,
local, and donated funds to be expended, even if they are not used to match Federal funds
The following information may be provided on the CFS-101 Part II or in the narrative of the
CFSP/APSR:
Columns I and J.
Estimated Number to be Served: Estimate, as accurately as possible, the
number of individuals and families to be served by service/activity with the total estimated funding
indicated.
Column K.
Population to be Served: Indicate the population that has been targeted for
the designated services. Targeting may include a range of vulnerable populations such as:
•
•
•
•
•
•
•

Children at imminent risk of placement;
All children in foster care;
Families with children returning home following placement;
All eligible children, eligible children under 21 years, or eligible children requiring
treatment;
Families with a child abuse or neglect investigation;
Children in contracted care; or
Families in crisis.

Column L. Geographic Area to be Served: Indicate both the number and type of areas
identified within the State where services are to be provided for each program. Areas may include
specific regions, counties, cities, reservations, communities, census tracts, or neighborhoods. For
example, if the State is operating family preservation programs in six counties, indicate by noting
"6 counties"; if the State is operating 12 community-based family support programs, indicate by
noting "12 communities".

CFS-101, Part II
U. S. Department of Health and Human Services
Administration for Children and Families

Attachment B
OMB Approval #0970-0426
Approved through September 30, 2017

CFS-101 Part II: Annual Estimated Expenditure Summary of Child and Family Services
State or Indian Tribal Organization ( ITO):

SERVICES/ACTIVITIES

1.) PROTECTIVE SERVICES
2.) CRISIS INTERVENTION (FAMILY
PRESERVATION)
3.) PREVENTION & SUPPORT
SERVICES (FAMILY SUPPORT)
4.) TIME-LIMITED FAMILY
REUNIFICATION SERVICES
5.) ADOPTION PROMOTION AND
SUPPORT SERVICES
6.) FOR OTHER SERVICE RELATED
ACTIVITIES (e.g. planning)
7.) FOSTER CARE MAINTENANCE:
(a) FOSTER FAMILY & RELATIVE
FOSTER CARE
(b) GROUP/INST CARE
8.) ADOPTION SUBSIDY PMTS.
9.) GUARDIANSHIP ASSIST. PMTS.
10.) INDEPENDENT LIVING SERVICES
11.) EDUCATION AND TRAINING
VOUCHERS
12.) ADMINISTRATIVE COSTS
13.) FOSTER PARENT RECRUITMENT &
TRAINING
14.) ADOPTIVE PARENT
RECRUITMENT & TRAINING
15.) CHILD CARE RELATED TO
EMPLOYMENT/TRAINING
16.) STAFF & EXTERNAL PARTNERS
TRAINING
17.) CASEWORKER RETENTION,
RECRUITMENT & TRAINING
18.) TOTAL

No Data

(e)
CFCIP

(f)
ETV

For FY 2017: OCTOBER 1, 2016 TO SEPTEMBER 30, 2017
(h)
(i)
(j)
STATE,
Number Number
(k)
(g)
(l)
TITLE IV- LOCAL, & Individuals Families POPULATION GEOG. AREA
To Be
DONATED
To Be TO BE SERVED TO BE SERVED
E**
Served
FUNDS
Served

No Data

No Data
-

* These columns are for States only; Indian Tribes are not required to include information on these programs.
** Only states or tribes operating an approved title IV-E waiver demonstration may enter information for rows 1-6 in column (g),
indicating planned use of title IV-E funds for these purposes.

2017 APSR

CFS-101, Part III

U.S. Department of Health and Human Services
Administration for Children and Families

Attachment B

OMB Approval #0970-0426
Approved through September 30, 2017

CFS-101, Part III: Expenditures for Title IV-B, Subparts 1 and 2, Chafee Foster Care
Independence (CFCIP) and Education and Training Voucher (ETV) Programs
Important Note on Completing the CFS-101, Part III: Formatting changes have been
made to the spreadsheet for the CFS 101, Part III beginning with reporting year October 1,
2013 through September 30, 2014. It is important for states, tribes, and territories to use
the updated version of this form to ensure compliance with Federal requirements to make
electronic information posted on websites accessible to people with disabilities. The
revised form includes cells in the Estimated Expenditures and Actual Expenditures
columns that have been prepopulated with a dash (-). To report data for items in these
columns, replace the dash (-) with the appropriate numeric dollar amount. The columns
requesting Number of Individuals, Number of Families, Population Served, and
Geographic Area have been prepopulated with “NA” (meaning that the item is not
applicable). To report data in these cells, replace the “NA” with the applicable
information. If no information is being reported in a cell, the cell should not be changed in
any way.

Note: Federal funds for the most of the programs identified above are awarded to States or Tribes
on a yearly basis, but may be spent over a two-year period ending on September 30 of the year
following the year in which they were awarded. For example, the FY 2014 grant allocation has
an expenditure period from October 1, 2013 to September 30, 2014. Therefore, any fiscal year
2014 funds must be obligated during that two-year period of time and subsequently reported on
this form.
Most figures in the "estimate" column can be found in a State's/Tribe's previously approved CFS
101, Part I for the fiscal year being reported on.
1.

State or ITO: Enter the name of the State or Indian Tribal Organization (ITO).

EIN: Indicate the Employer Identification Number (EIN).

Address: Enter the address of the State or ITO Agency.

Submission: Indicate if this is a new or revised expenditure report.

5. Total title IV-B, subpart 1 funds: Indicate the estimated expenditures, and actual
expenditures of title IV-B, subpart 1 Federal funds for the designated fiscal year for Child
Welfare Services. (The estimated expenditure total should equal the amount of the grant
awarded for the designated fiscal year.) Indicate as accurately as possible, the number of
individuals and the number of families served, the population served, and the geographic area
where services were provided. The required 25% match should not be reflected on this form.

CFS-101, Part III

U.S. Department of Health and Human Services
Administration for Children and Families

Attachment B

OMB Approval #0970-0426
Approved through September 30, 2017

a) Specify the estimated allotment and actual expenditures of title IV-B, subpart 1 funds
for administration. Note that administrative costs may not exceed 10% of the title IV-B,
subpart 1 total expenditures.
6. Total title IV-B, subpart 2 Promoting Safe and Stable Families (PSSF) funds: Indicate
the estimated expenditures, actual expenditures of title IV-B, subpart 2 funds for the designated
fiscal year for Promoting Safe and Stable Families services. (The estimated expenditure total
should equal the amount of the grant awarded for the designated fiscal year.) The required 25%
match should not be reflected on this form. Indicate as accurately as possible, the number of
individuals and the number of families served, 1 the population served, 2 and the geographic area
where services were provided. 3 States must also complete lines 6 a – f; for Tribes this is
optional.
a) Indicate the estimated allotment and actual expenditures of title IV-B, subpart 2 PSSF
funds for the designated fiscal year for Family Preservation Services. Note that these
funds may be spent over a two-year period ending on September 30 of the fiscal year
following the year in which they were awarded.
b) Indicate the estimated and actual expenditures of title IV-B, subpart 2 PSSF funds
allotted for the designated fiscal year for Family Support Services. Note that these
funds may be spent over a two-year period ending on September 30 of the fiscal year
following the year in which they were awarded.
c) Indicate the estimated and actual expenditures of title IV-B, subpart 2 PSSF funds
allotted for the designated fiscal year for Time-Limited Family Reunification Services.
Note that these funds may be spent over a two-year period ending on September 30 of the
fiscal year following the year in which they were awarded.
d) Indicate the estimated and actual expenditures of title IV-B, subpart 2 PSSF funds
allotted for the designated fiscal year for Adoption Promotion and Support Services.
Note that these funds may be spent over a two-year period ending on September 30 of the
year following that in which they were awarded.
e) Indicate the estimated and actual expenditures of title IV-B, subpart 2 PSSF funds
Report, as accurately as possible, the number of clients served per service/activity for the amount of funds
expended. Indicate the number of individuals and the number of families served as labeled in the column.

Indicate the population that has received the designated services. This may include a range of vulnerable
populations such as children at imminent risk of placement, all children in foster care, families with children
returning home following placement, all eligible children, eligible children under 21 years, or eligible children
requiring treatment, families with a child abuse or neglect investigation, children in contracted care, and/or families
in crisis.
3
Indicate the number and type of areas identified within the State where services are to be provided for each
program. Areas may include specific regions, counties, cities, reservations, communities, census tracts, or
neighborhoods.
2

CFS-101, Part III

U.S. Department of Health and Human Services
Administration for Children and Families

Attachment B

OMB Approval #0970-0426
Approved through September 30, 2017

allotted for the designated fiscal year for other service related activities (e.g. planning).
Note that these funds may be spent over a two-year period ending on September 30 of the
fiscal year following the year in which they were awarded.
f) Indicate the estimated and actual expenditures of title IV-B, subpart 2 PSSF funds
allotted for the designated fiscal year for administrative costs. Note that these funds may
be spent over a two-year period ending on September 30 of the fiscal year following the
year in which they were awarded. Beginning in FFY 2008, States’ administrative costs
may not exceed 10% of the total Federal expenditures for title IV-B, subpart 2. (This
limitation does not apply to Tribes.)
7. Total title IV-B subpart 2, Monthly Caseworker Visit (MCV) Funds (States only):
Indicate the estimated and actual expenditures allotted for the designated fiscal year. Note that
with the exception of FY 2006 grants, these funds may be spent over a two-year period ending
on September 30 of the fiscal year following the year in which they were awarded.
a). Indicate the estimated and actual expenditures of title IV-B, subpart 2 Monthly
Caseworker Visit funds allotted for the designated fiscal year (States only). Note that
these funds may be spent over a two-year period ending on September 30 of the fiscal
year following the year in which they were awarded. Beginning in FFY 2008 total
administrative costs may not exceed 10% of the total expenditures for MCV.
8.
Chafee Foster Care Independence Program (CFCIP) Funds: Indicate the estimated
and actual expenditures of CFCIP funds allotted for the designated fiscal year for independent
living activities as provided in the APSR or CFSP Program Instruction.
a) Indicate the estimated and actual expenditures of the State's or Tribe’s allotment for the
designated fiscal year for room and board for eligible youth (not to exceed 30% of CFCIP
funds). Note that these funds may be spent over a two-year period ending on September
30 of the fiscal year following they year in which they were awarded. Indicate as
accurately as possible, the number of clients served, the population served, and the
geographic area where services were provided.
9.
Education and Training Vouchers (ETV) Program: Indicate the estimated and actual
expenditures of Education and Training Voucher funds allotted for the designated fiscal year as
provided in the annual Program Instruction on the APSR or CFSP. Indicate as accurately as
possible, the number of clients served, the population served, and the geographic area where
services were provided.
10.
Certification: This report must be signed and dated in the spaces provided. The
signature and title must be included of the official of the State agency, or Indian Tribal
Organization, with authority to administer or supervise the administration of title IV-B, subparts
1 and 2 programs and, for States only, MCV and CAPTA programs.
By signing this form the State/Tribal official certifies that all figures provided here are accurate.
3

CFS-101, Part III

U.S. Department of Health and Human Services
Administration for Children and Families

Attachment B

OMB Approval #0970-0426
Approved through September 30, 2017

* Title IV-B, subpart 2 includes both the Promoting Safe and Stable Families Program and the
Monthly Caseworker Visit Program.

CFS-101, Part III
U. S. Department of Health and Human Services
Administration for Children and Families

Attachment B
OMB Approval #0970-0426
Approved through September 30,2017

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 2014: October 1, 2013 through September 30, 2014
1. State or Indian Tribal Organization (ITO):
4. Submission:

[

] New

[

2. EIN:

3. Address:

] Revision
Estimated
Expenditures

Description of Funds

Actual
Expenditures

5. Total title IV-B, subpart 1 funds
a) Total Administrative Costs (not to exceed 10% of title IV-B,
subpart 1 total allotment)
6. Total title IV-B, subpart 2 funds (This amount should equal the
sum of lines a - f.)
a) Family Preservation Services

- $

b) Family Support Services

c) Time-Limited Family Reunification Services
d) Adoption Promotion and Support Services
e) Other Service Related Activities (e.g. planning)
f) Administrative Costs (FOR STATES: not to exceed 10% of
total title IV-B, subpart 2 allotment after October 1, 2007)
7. Total Monthly Caseworker Visit Funds (STATE ONLY)
a) Administrative Costs (not to exceed 10% of MCV allotment)
8. Total Chafee Foster Care Independence Program (CFCIP)
funds
a) Indicate the amount of allotment spent on room and board for
eligible youth (not to exceed 30% of CFCIP allotment)
9. Total Education and Training Voucher (ETV) funds

Number
Individuals
served

Number
Families
served

Population
served

Geographic area served

No Data

$
- $
- $

No Data

$
$

- $
- $

No Data

- $

No Data

- $

No Data

- $

NA
NA
NA
$
- $
10. 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.

Signature and Title of State/Tribal Agency Official

Date

Signature and Title
of Central Office
Official

Date

2017 APSR

File Type	application/pdf
File Title	ACYF-CB-PI-16-03
Subject	June 30, 2016, submission of: (1) the second Annual Progress and Services Report (APSR) to the 2015-2019 Child and Family Servic
Author	H H S / Children’s Bureau
File Modified	2017-03-15
File Created	2017-03-15