Attachment I: ANNUAL BUDGET REQUEST FOR TITLE IV-B FUNDS

ANNUAL BUDGET REQUEST FOR TITLE IV-B FUNDS
State of Fiscal Year Revision #
October 1, 19 through September 30, 19

COMPUTATION OF FEDERAL GRANT AWARD
1. Total estimated Title IV-B expenditures
2. Enter Federal Share (75% of A up to maximum listed in Action Transmittal)
REQUEST FOR GRANT AWARD

Indicate the total request for the year and the request for each of the four quarters. (funds totaling more than the State's share of the $141 million allotment will not be released to the State until there has been verification that the State meets the conditions of P.L. 96-272 for those funds).

Total (from line I.B)

1st Quarter 2nd Quarter 3rd Quarter 4th Quarter

(Oct. - Dec.) (Jan. - Mar.) (Apr. - Jun.) (Jul. - Sept.)
CERTIFICATION BY STATE AGENCY

The State Agency submits the above estimate and request of grant award under Title IV-B of the Social Security Act, as amended, and agrees that the estimated expenditures will be made in accordance with the Child Welfare Services Plan, agreed to by the Agency and the Administration for Children, Youth and Families for the fiscal year ending September 30

DO NOT WRITE IN THIS SPACE

___________________________ __________________________

(Signature) Administrator Date Regional Office Approval

___________________________

Single State Agency

___________________________

(Title) Regional Program Director

___________________________ __________________________

(Signature) Director Date

___________________________ __________________________

Single Organization Unit Date

___________________________

(Title)

___________________________ __________________________

(Signature) Other State Official Date
(optional)

___________________________

(Title)

Instructions for Completion of Form CWS-101

Annual Budget Request for Title IV-B Funds

Computation of Federal Grant Award:

Each State should base its request on its share of the $141 million allotment until it has been certified as meeting the criteria establishing its eligibility to receive its share of funds beyond the $141 million allotment.
1. This is the total the State expects to spend during the year based upon its current eligibility.
2. This figure is 75% of the amount in A, but is limited by the State's allotment as specified in the appropriate Action Transmittal.
Funds will be awarded to each State based on the amount requested for each quarter. No quarterly submissions are required except to amend the original request.
The signatures of both the Administrator of the Single State Agency and the Director of the State Single Organizational Unit are required.

Note: This budget request is subject to the A-95 approval process.

Attachments:

Attachment II: State Grant Table showing tentative FY 1981 apportionment of Federal Child Welfare Services State Grant Funds
Attachment III Notes on possible direct payments to Indian tribal organizations